Individual provider · NPI-1

Larry Cleveland, RD, LD, LMT

Dietitian, Registered · Denton, TX

NPI number1104064138
StatusActive
Last updated in NPPESJun 28, 2010

Details

NPI
1104064138
Entity type
Individual (NPI-1)
Name
Larry Cleveland
Credential
RD, LD, LMT
Sex
Male
Sole proprietor
Yes
Enumeration date
Jan 29, 2009
Last updated
Jun 28, 2010

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
133V00000X Dietitian, Registered847306TXYes
133V00000X Dietitian, RegisteredDT06352TX

Practice location

2430 S I-35 E Ste 128
Denton, TX 76205-4943

Phone 972-824-5011

Mailing address

2430 S I-35 E Ste 128
Denton, TX 76205-4943

Phone 972-824-5011

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