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General NPI Number Information
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NPI Number | 1831471176
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Entity Type | Organization
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Legal Business Name | BODY DYNAMICS
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 09/13/2011
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Provider Practice Location Address
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Address Line | 167 YACHT CLUB WAY 104
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City | HYPOLUXO
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State | FL
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Zip | 33462-6061
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Country | US
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Telephone | 305-924-7319
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Fax |
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Provider Business Mailing Address
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Address Line | 167 YACHT CLUB WAY 104
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City | HYPOLUXO
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State | FL
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Zip | 33462-6061
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Country | US
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Telephone | 305-924-7319
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Fax |
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Authorized Official
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Title or Position | OWNER, RD
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Name | ANDREA SUSANNE SZEBNI
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Credential | M.S., R.D., LD/N
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Telephone | 305-924-7319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | ND 5971
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 1044812
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License Number State | FL
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