Healthcare Provider Details

I. General information

NPI: 1376465690
Provider Name (Legal Business Name): COACH DEE FITNESS AND NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2922 OAK FOREST DR
GRAPEVINE TX
76051-3856
US

IV. Provider business mailing address

2922 OAK FOREST DR
GRAPEVINE TX
76051-3856
US

V. Phone/Fax

Practice location:
  • Phone: 254-338-3902
  • Fax:
Mailing address:
  • Phone: 254-338-3902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEMETRICES ANTWAN ROBINSON
Title or Position: OWNER/DIETITIAN
Credential: ROBINSON
Phone: 254-338-3902