Provider Demographics
NPI:1942637038
Name:TOTAL HEALTH AND FITNESS, LLC
Entity Type:Organization
Organization Name:TOTAL HEALTH AND FITNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:WIRTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD
Authorized Official - Phone:801-572-8050
Mailing Address - Street 1:767 E 12300 S STE B
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9587
Mailing Address - Country:US
Mailing Address - Phone:801-572-8050
Mailing Address - Fax:
Practice Address - Street 1:767 E 12300 S STE B
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9587
Practice Address - Country:US
Practice Address - Phone:801-572-8050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT86015229133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty