Provider Demographics
NPI:1619115078
Name:DUKE DIET AND FITNESS CENTER
Entity Type:Organization
Organization Name:DUKE DIET AND FITNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:RYDIN-GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-684-4692
Mailing Address - Street 1:501 DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3888
Mailing Address - Country:US
Mailing Address - Phone:919-684-4692
Mailing Address - Fax:
Practice Address - Street 1:501 DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3888
Practice Address - Country:US
Practice Address - Phone:919-684-4692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3619320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities