Healthcare Provider Details

I. General information

NPI: 1346119534
Provider Name (Legal Business Name): DYSONFIT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 ALANIS DR STE 230
WYLIE TX
75098-4185
US

IV. Provider business mailing address

1001 ALANIS DR STE 230
WYLIE TX
75098-4185
US

V. Phone/Fax

Practice location:
  • Phone: 972-885-3517
  • Fax:
Mailing address:
  • Phone: 972-885-3517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: GERALD DYSON
Title or Position: OWNER
Credential: HHP
Phone: 214-469-7588