Provider Demographics
NPI:1740557685
Name:TEMPLAR INDUSTRIES, INC
Entity Type:Organization
Organization Name:TEMPLAR INDUSTRIES, INC
Other - Org Name:THE INSTITUTE OF SPORT SCIENCE AND ATHLETIC CONDITIONING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LACY
Authorized Official - Middle Name:
Authorized Official - Last Name:PUTTUCK
Authorized Official - Suffix:
Authorized Official - Credentials:RD,CISSN, CSCS, USAW
Authorized Official - Phone:702-567-3495
Mailing Address - Street 1:6445 S TENAYA WAY
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-1989
Mailing Address - Country:US
Mailing Address - Phone:702-567-3495
Mailing Address - Fax:
Practice Address - Street 1:6445 S TENAYA WAY
Practice Address - Street 2:SUITE 160
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-1989
Practice Address - Country:US
Practice Address - Phone:702-567-3495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty