Provider Demographics
NPI:1154895282
Name:DTS FITNESS
Entity type:Organization
Organization Name:DTS FITNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LASWANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAYDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-774-9496
Mailing Address - Street 1:2515 E ROSEMEADE PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2036
Mailing Address - Country:US
Mailing Address - Phone:469-758-6859
Mailing Address - Fax:
Practice Address - Street 1:2515 E ROSEMEADE PKWY STE 400
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2036
Practice Address - Country:US
Practice Address - Phone:469-758-6859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty