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General NPI Number Information
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NPI Number | 1255163119
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Entity Type | Organization
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Legal Business Name | PHILADELPHIA FUNCTIONAL NUTRITION, LLC
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Dates
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Enumeration Date | 08/19/2024
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Last Update Date | 08/19/2024
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Provider Practice Location Address
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Address Line | 237 W LANCASTER AVE STE 215
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City | DEVON
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State | PA
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Zip | 19333-1585
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Country | US
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Telephone | 484-693-0660
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Fax | 484-643-4500
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Provider Business Mailing Address
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Address Line | 237 W LANCASTER AVE STE 215
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City | DEVON
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State | PA
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Zip | 19333-1585
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Country | US
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Telephone | 484-693-0660
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RACHEL HERSHBERGER
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Credential | CNS LDN
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Telephone | 484-693-0660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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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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