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General NPI Number Information
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NPI Number | 1063809630
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Entity Type | Organization
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Legal Business Name | NUTRAPY, LLC
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Dates
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Enumeration Date | 04/22/2015
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Last Update Date | 04/22/2015
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Provider Practice Location Address
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Address Line | 412 WASHINGTON ST (INSIDE NORWELL ATHLETIC CENTER)
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City | NORWELL
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State | MA
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Zip | 02061-2056
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Country | US
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Telephone | 508-685-4033
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Fax |
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Provider Business Mailing Address
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Address Line | 412 WASHINGTON ST (INSIDE NORWELL ATHLETIC CENTER)
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City | NORWELL
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State | MA
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Zip | 02061-2056
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Country | US
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Telephone | 508-685-4033
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | MR. JIMMY CHUNG DUONG
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Credential | L.M.T.
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Telephone | 508-685-4033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 9250
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License Number State | MA
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