Provider Demographics
NPI:1881148492
Name:ATHLETES PERFORMANCE ARIZONA LLC
Entity type:Organization
Organization Name:ATHLETES PERFORMANCE ARIZONA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, NUTRITION & RESEARCH
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CSSD
Authorized Official - Phone:480-449-9000
Mailing Address - Street 1:2629 E ROSE GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4605
Mailing Address - Country:US
Mailing Address - Phone:480-449-9000
Mailing Address - Fax:480-449-9200
Practice Address - Street 1:2629 E ROSE GARDEN LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4605
Practice Address - Country:US
Practice Address - Phone:480-449-9000
Practice Address - Fax:480-449-9200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATHLETES PERFORMANCE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty