Provider Demographics
NPI:1316783624
Name:ISAIAH 40:31 FITNESS LLC
Entity type:Organization
Organization Name:ISAIAH 40:31 FITNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-321-3497
Mailing Address - Street 1:4715 HIGHWAY 36 S STE 8
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-2527
Mailing Address - Country:US
Mailing Address - Phone:515-321-3497
Mailing Address - Fax:
Practice Address - Street 1:4715 HIGHWAY 36 S STE 8
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-2527
Practice Address - Country:US
Practice Address - Phone:515-321-3497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:803897931
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-05
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty