Provider Demographics
NPI:1306441514
Name:VITA THERAPY PLLC
Entity type:Organization
Organization Name:VITA THERAPY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:POPPITO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:646-853-4376
Mailing Address - Street 1:8703 FLINT FALLS DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-7540
Mailing Address - Country:US
Mailing Address - Phone:646-853-4376
Mailing Address - Fax:
Practice Address - Street 1:10000 N CENTRAL EXPY STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4180
Practice Address - Country:US
Practice Address - Phone:646-853-4376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHANNON R. POPPITO, PHD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-03
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty