MEDICARE: REBECCA DORITY R.D.L.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	D706104	TX

General Provider Information

NPI Number	:	1659319044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA DORITY R.D.L.D.

Provider Business Mailing Address
First Line	:	9003 AIRPORT FWY
Second Line	:	SUITE 300
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-7770
Country	:	US
Telephone Number	:	817-514-5200
Fax Number	:	817-514-5210

Provider Business Practice Location Address
First Line	:	1735 KELLER SPRINGS RD
Second Line	:	SUITE 100
City	:	CARROLLTON
State	:	TX
Zip	:	75006-2962
Country	:	US
Telephone Number	:	972-242-0185
Fax Number	:	972-245-9490

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	07/08/2007

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