Healthcare Provider Details

I. General information

NPI: 1013971381
Provider Name (Legal Business Name): FOOD PHYSICS & BODY DYNAMICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 09/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2826 BELLWOOD AVE
CASTLE HAYNE NC
28429-6506
US

IV. Provider business mailing address

PO BOX 56
CASTLE HAYNE NC
28429-0056
US

V. Phone/Fax

Practice location:
  • Phone: 910-777-7307
  • Fax:
Mailing address:
  • Phone: 910-777-7307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberU02298
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU02298
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code246Y00000X
TaxonomyHealth Information Specialist/Technologist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License NumberU02298
License Number StateMD

VIII. Authorized Official

Name: MS. LAURA L DAWSON
Title or Position: DIRECTOR
Credential: MAOM, DIPL.AC., L.AC
Phone: 910-777-7307