Provider Demographics
NPI:1437797420
Name:NUTRITION IN MOTION
Entity Type:Organization
Organization Name:NUTRITION IN MOTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DORVAL
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:888-964-1975
Mailing Address - Street 1:80 PALOMINO LN STE 101
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6447
Mailing Address - Country:US
Mailing Address - Phone:888-964-1975
Mailing Address - Fax:
Practice Address - Street 1:150 S PINE ISLAND RD STE 300
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2665
Practice Address - Country:US
Practice Address - Phone:888-964-1975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NUTRITION IN MOTION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty