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General NPI Number Information
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NPI Number | 1154895282
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Entity Type | Organization
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Legal Business Name | DTS FITNESS
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Dates
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Enumeration Date | 01/11/2019
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Last Update Date | 01/11/2019
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Provider Practice Location Address
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Address Line | 2515 E ROSEMEADE PKWY STE 400
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City | CARROLLTON
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State | TX
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Zip | 75007-2036
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Country | US
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Telephone | 469-758-6859
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Fax |
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Provider Business Mailing Address
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Address Line | 2515 E ROSEMEADE PKWY STE 400
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City | CARROLLTON
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State | TX
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Zip | 75007-2036
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Country | US
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Telephone | 469-758-6859
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LASWANDRA GRAYDON
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Credential |
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Telephone | 469-774-9496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TE1100X
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Taxonomy Name | Exercise & Sports Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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