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General NPI Number Information
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NPI Number | 1467599001
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Entity Type | Organization
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Legal Business Name | TOTAL NUTRITION TECHNOLOGY, INC.
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 03/08/2022
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Provider Practice Location Address
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Address Line | 10400 MALLARD CREEK RD STE 340
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City | CHARLOTTE
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State | NC
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Zip | 28262-5203
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Country | US
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Telephone | 704-549-9550
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Fax | 704-549-9570
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Provider Business Mailing Address
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Address Line | 10400 MALLARD CREEK RD STE 340
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City | CHARLOTTE
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State | NC
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Zip | 28262-5203
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Country | US
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Telephone | 704-549-9550
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Fax | 704-549-9570
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Authorized Official
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Title or Position | FOUNDER, PRESIDENT
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Name | ANGELA GALLO WILKINSON
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Credential | RD, LDN
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Telephone | 704-549-9550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1004X
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Taxonomy Name | Pediatric Nutrition 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 | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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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 | 136A00000X
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Taxonomy Name | Registered Dietetic Technician
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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 | 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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