Provider Demographics
NPI:1588477681
Name:ROOTED IN LIFESTYLE, L.L.C.
Entity type:Organization
Organization Name:ROOTED IN LIFESTYLE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:DOROTHIE
Authorized Official - Last Name:JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-262-9007
Mailing Address - Street 1:600 HERITAGE DR.
Mailing Address - Street 2:SUITE 210
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3097
Mailing Address - Country:US
Mailing Address - Phone:786-262-9007
Mailing Address - Fax:561-370-3081
Practice Address - Street 1:600 HERITAGE DR.
Practice Address - Street 2:SUITE 210
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3097
Practice Address - Country:US
Practice Address - Phone:786-262-9007
Practice Address - Fax:561-370-3081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty