Healthcare Provider Details

I. General information

NPI: 1972426096
Provider Name (Legal Business Name): GUT THEORY TOTAL DIGESTIVE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 WISCONSIN AVE NW STE 200B
WASHINGTON DC
20015-2014
US

IV. Provider business mailing address

5225 WISCONSIN AVE NW STE 200B
WASHINGTON DC
20015-2014
US

V. Phone/Fax

Practice location:
  • Phone: 888-755-4881
  • Fax: 888-755-4881
Mailing address:
  • Phone: 888-755-4881
  • Fax: 888-755-4881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: JANESE SHADE' LASTER-BUTLER
Title or Position: OWNER/CEO
Credential: MD
Phone: 888-755-4881