Provider Demographics
NPI:1184244774
Name:RESILIENT ROOTS: FUNCTIONAL AND EVOLUTIONARY MEDICINE
Entity type:Organization
Organization Name:RESILIENT ROOTS: FUNCTIONAL AND EVOLUTIONARY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-320-9383
Mailing Address - Street 1:925 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5572
Mailing Address - Country:US
Mailing Address - Phone:434-218-3425
Mailing Address - Fax:434-215-0727
Practice Address - Street 1:925 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5572
Practice Address - Country:US
Practice Address - Phone:434-218-3425
Practice Address - Fax:434-215-0727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty