Provider Demographics
NPI:1548419237
Name:TOTALLY FIT 4 LIFE PLLC
Entity Type:Organization
Organization Name:TOTALLY FIT 4 LIFE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:704-822-5433
Mailing Address - Street 1:7476 WATERSIDE LOOP RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-7679
Mailing Address - Country:US
Mailing Address - Phone:704-822-5433
Mailing Address - Fax:
Practice Address - Street 1:7476 WATERSIDE LOOP RD
Practice Address - Street 2:SUITE 600
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-7679
Practice Address - Country:US
Practice Address - Phone:704-822-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1289672084B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0002XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyObesity MedicineGroup - Single Specialty