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General NPI Number Information
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NPI Number | 1972677326
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Entity Type | Organization
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Legal Business Name | NATICK SPORTS AND RACQUET CLUB
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Dates
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Enumeration Date | 11/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 203 OAK ST LONGFELLOW SPORTS CLUB
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City | NATICK
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State | MA
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Zip | 01760-1306
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Country | US
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Telephone | 508-653-4633
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Fax | 508-650-4986
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Provider Business Mailing Address
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Address Line | 203 OAK ST LONGFELLOW SPORTS CLUB
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City | NATICK
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State | MA
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Zip | 01760-1306
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Country | US
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Telephone | 508-653-4633
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Fax | 508-650-4986
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Authorized Official
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Title or Position | DIETITIAN
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Name | MISS JANE POLLEY
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Credential | M.S., R.D., LDN
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Telephone | 508-653-4633
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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 | LDN1011
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License Number State | MA
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