Provider Demographics
NPI:1760099360
Name:TAG VIRTUAL WELLNESS LLC
Entity type:Organization
Organization Name:TAG VIRTUAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER- TAG VIRTUAL WELLNESS LLC
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:GIRARD
Authorized Official - Suffix:
Authorized Official - Credentials:MSRD
Authorized Official - Phone:877-667-7282
Mailing Address - Street 1:408 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-2222
Mailing Address - Country:US
Mailing Address - Phone:617-293-9978
Mailing Address - Fax:877-667-7282
Practice Address - Street 1:408 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-2222
Practice Address - Country:US
Practice Address - Phone:877-667-7282
Practice Address - Fax:833-929-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty