Provider Demographics
NPI:1821526153
Name:NUTRITION & FITNESS ON THE MOVE LLC
Entity Type:Organization
Organization Name:NUTRITION & FITNESS ON THE MOVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANTELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BETHEA
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:703-980-9842
Mailing Address - Street 1:3622 SERENDIPITY RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-1093
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3622 SERENDIPITY RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1093
Practice Address - Country:US
Practice Address - Phone:703-980-9842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDX3601133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty