Healthcare Provider Details

I. General information

NPI: 1750787610
Provider Name (Legal Business Name): YOUR WELLNESS CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 TYSON AVE
PHILADELPHIA PA
19149-1415
US

IV. Provider business mailing address

1 PRESIDENTIAL BLVD STE 203
BALA CYNWYD PA
19004-1007
US

V. Phone/Fax

Practice location:
  • Phone: 610-331-5439
  • Fax:
Mailing address:
  • Phone: 610-331-5439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN004701
License Number StatePA

VIII. Authorized Official

Name: MS. DANIELLE DIMARCO
Title or Position: PARTNER/REGISTERED DIETITIAN
Credential: MS, RD, LDN, CPT
Phone: 610-331-5439