MEDICARE: MESOMORPHEUS LLC

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	133N00000X	Nutritionist
2	174H00000X	Health Educator

General Provider Information

NPI Number	:	1851871396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MESOMORPHEUS LLC

Provider Business Mailing Address
First Line	:	PO BOX 19374
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80308-2374
Country	:	US
Telephone Number	:	720-772-1444
Fax Number	:	844-300-7826

Provider Business Practice Location Address
First Line	:	5485 CONESTOGA CT STE 110B
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-2752
Country	:	US
Telephone Number	:	720-772-1444
Fax Number	:	844-300-7826

Authorized Official
Title or Position	:	PERSONAL TRAINER & NUTRITIONIST
Name	:	MR. JOSEPH WILLIAM ESLER
Credential	:
Telephone Number	:	720-772-1444

Provider Enumeration Date	:	08/15/2018
Last Update Date	:	06/11/2019

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Directions to “MESOMORPHEUS LLC ” Practice Location

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