Provider Demographics
NPI:1851801245
Name:HYDE PARK FITNESS
Entity Type:Organization
Organization Name:HYDE PARK FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ABBEY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:435-374-9586
Mailing Address - Street 1:609 N 50 E
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84335-2228
Mailing Address - Country:US
Mailing Address - Phone:435-374-9586
Mailing Address - Fax:
Practice Address - Street 1:3935 N 75 W
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:UT
Practice Address - Zip Code:84318-4111
Practice Address - Country:US
Practice Address - Phone:435-374-9586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8772877-4901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty