Provider Demographics
NPI:1386233880
Name:SOUTHWEST OHIO FITNESS & NUTRITION
Entity type:Organization
Organization Name:SOUTHWEST OHIO FITNESS & NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RD/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:903-920-1315
Mailing Address - Street 1:47 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CEDARVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45314-8559
Mailing Address - Country:US
Mailing Address - Phone:903-920-1315
Mailing Address - Fax:
Practice Address - Street 1:29 KYLE DR
Practice Address - Street 2:
Practice Address - City:CEDARVILLE
Practice Address - State:OH
Practice Address - Zip Code:45314-9580
Practice Address - Country:US
Practice Address - Phone:937-766-2611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty