Provider Demographics
NPI:1497456784
Name:EMBODIED NUTRITION THERAPY LLC
Entity Type:Organization
Organization Name:EMBODIED NUTRITION THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGLUND
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:832-597-7275
Mailing Address - Street 1:2020 HADDON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-5744
Mailing Address - Country:US
Mailing Address - Phone:832-457-8027
Mailing Address - Fax:
Practice Address - Street 1:11703 SPRING CYPRESS RD STE W
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-8932
Practice Address - Country:US
Practice Address - Phone:832-597-7275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty