Provider Demographics
NPI:1487662854
Name:THE FITNESS FORMULA, INC.
Entity type:Organization
Organization Name:THE FITNESS FORMULA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, RD, LD, LPC
Authorized Official - Phone:972-238-1811
Mailing Address - Street 1:1177 ROCKINGHAM
Mailing Address - Street 2:STE 128
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75205
Mailing Address - Country:US
Mailing Address - Phone:972-238-1811
Mailing Address - Fax:972-690-3755
Practice Address - Street 1:1177 ROCKINGHAM LN
Practice Address - Street 2:STE 128
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75205-4373
Practice Address - Country:US
Practice Address - Phone:972-238-1811
Practice Address - Fax:972-690-3755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty