MEDICARE: DTS FITNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TE1100X	Exercise & Sports Psychologist
2	133N00000X	Nutritionist
3	225700000X	Massage Therapist
4	261QP2000X	Physical Therapy Clinic/Center
5	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1154895282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DTS FITNESS

Provider Business Mailing Address
First Line	:	2515 E ROSEMEADE PKWY STE 400
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-2036
Country	:	US
Telephone Number	:	469-758-6859
Fax Number	:

Provider Business Practice Location Address
First Line	:	2515 E ROSEMEADE PKWY STE 400
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-2036
Country	:	US
Telephone Number	:	469-758-6859
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LASWANDRA GRAYDON
Credential	:
Telephone Number	:	469-774-9496

Provider Enumeration Date	:	01/11/2019
Last Update Date	:	01/11/2019

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Directions to “DTS FITNESS ” Practice Location

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