Provider Demographics
NPI:1932508298
Name:FOOD AND FITNESS LLC
Entity Type:Organization
Organization Name:FOOD AND FITNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARADIS
Authorized Official - Suffix:
Authorized Official - Credentials:DIETICIAN
Authorized Official - Phone:570-503-6635
Mailing Address - Street 1:982 N GARDEN RIDGE BLVD
Mailing Address - Street 2:STE 140
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2827
Mailing Address - Country:US
Mailing Address - Phone:570-503-6635
Mailing Address - Fax:
Practice Address - Street 1:982 N GARDEN RIDGE BLVD
Practice Address - Street 2:STE 140
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-2827
Practice Address - Country:US
Practice Address - Phone:570-503-6635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1067446133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty