Provider Demographics
NPI:1255974523
Name:MAPLE, MARETTA M (FITNESS PT AND NUTRI)
Entity type:Individual
Prefix:
First Name:MARETTA
Middle Name:M
Last Name:MAPLE
Suffix:
Gender:F
Credentials:FITNESS PT AND NUTRI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14010 VALLEY GROVE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-5523
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14010 VALLEY GROVE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77066-5523
Practice Address - Country:US
Practice Address - Phone:256-682-7597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-19
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171R00000XOther Service ProvidersInterpreter