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General NPI Number Information
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NPI Number | 1275832149
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Entity Type | Organization
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Legal Business Name | TOP DOG NUTRITION & FITNESS
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Dates
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Enumeration Date | 03/18/2011
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Last Update Date | 03/18/2011
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Provider Practice Location Address
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Address Line | 4708 GIBSON RD #105
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-6042
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Country | US
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Telephone | 228-872-1749
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Fax | 228-872-1749
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Provider Business Mailing Address
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Address Line | 4708 GIBSON RD #105
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-6042
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Country | US
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Telephone | 228-872-1749
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Fax | 228-872-1749
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Authorized Official
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Title or Position | OPERATIONS MANAGER/CO-OWNER
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Name | MISS SHEENA JOY MYLES
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Credential |
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Telephone | 228-872-1749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | 241367
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 234140
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License Number State | FL
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