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General NPI Number Information
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NPI Number | 1588477681
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Entity Type | Organization
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Legal Business Name | ROOTED IN LIFESTYLE, L.L.C.
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Dates
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Enumeration Date | 01/31/2025
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 600 HERITAGE DR. SUITE 210
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City | JUPITER
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State | FL
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Zip | 33458-3097
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Country | US
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Telephone | 786-262-9007
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Fax | 561-370-3081
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Provider Business Mailing Address
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Address Line | 600 HERITAGE DR. SUITE 210
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City | JUPITER
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State | FL
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Zip | 33458-3097
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Country | US
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Telephone | 786-262-9007
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Fax | 561-370-3081
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Authorized Official
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Title or Position | PHYSICIAN MANAGER
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Name | MRS. LINDA DOROTHIE JEAN
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Credential | M.D.
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Telephone | 786-262-9007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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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 | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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