Provider Demographics
NPI:1851871396
Name:MESOMORPHEUS LLC
Entity Type:Organization
Organization Name:MESOMORPHEUS LLC
Other - Org Name:MESOMORPHEUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PERSONAL TRAINER & NUTRITIONIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ESLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-772-1444
Mailing Address - Street 1:PO BOX 19374
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-2374
Mailing Address - Country:US
Mailing Address - Phone:720-772-1444
Mailing Address - Fax:844-300-7826
Practice Address - Street 1:5485 CONESTOGA CT STE 110B
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2752
Practice Address - Country:US
Practice Address - Phone:720-772-1444
Practice Address - Fax:844-300-7826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty