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General NPI Number Information
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NPI Number | 1750787610
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Entity Type | Organization
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Legal Business Name | YOUR WELLNESS CONSULTANTS
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Dates
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Enumeration Date | 11/05/2014
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 2835 TYSON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19149-1415
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Country | US
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Telephone | 610-331-5439
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Fax |
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Provider Business Mailing Address
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Address Line | 1 PRESIDENTIAL BLVD STE 203
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1007
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Country | US
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Telephone | 610-331-5439
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Fax |
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Authorized Official
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Title or Position | PARTNER/REGISTERED DIETITIAN
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Name | MS. DANIELLE DIMARCO
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Credential | MS, RD, LDN, CPT
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Telephone | 610-331-5439
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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 | DN004701
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License Number State | PA
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