Provider Demographics
NPI:1558076117
Name:THRU THE LIFESPAN DIETITIANS LLC
Entity Type:Organization
Organization Name:THRU THE LIFESPAN DIETITIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-833-2622
Mailing Address - Street 1:19201 DOVE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3005
Mailing Address - Country:US
Mailing Address - Phone:813-833-2622
Mailing Address - Fax:
Practice Address - Street 1:19201 DOVE CREEK DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3005
Practice Address - Country:US
Practice Address - Phone:813-833-2622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty