Provider Demographics
NPI:1548539679
Name:PROFESSIONAL NUTRITION THERAPISTS, LLC
Entity type:Organization
Organization Name:PROFESSIONAL NUTRITION THERAPISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCHENRY
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LD, CDE
Authorized Official - Phone:972-238-1811
Mailing Address - Street 1:13490 TI BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1533
Mailing Address - Country:US
Mailing Address - Phone:972-238-1811
Mailing Address - Fax:800-888-9560
Practice Address - Street 1:13490 TI BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1533
Practice Address - Country:US
Practice Address - Phone:972-238-1811
Practice Address - Fax:800-888-9560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty