Organization · NPI-2

Back On Track Nutrition LLC

Dietitian, Registered · Tempe, AZ

NPI number1780297614
StatusActive
Last updated in NPPESNov 29, 2022

Details

NPI
1780297614
Entity type
Organization (NPI-2)
Legal business name
Back On Track Nutrition LLC
Organization subpart
No
Enumeration date
Aug 29, 2020
Certification date
Nov 29, 2022
Last updated
Nov 29, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
133V00000X Dietitian, Registered––Yes
133VN1201X Dietitian, Registered, Nutrition, Obesity and Weight Management––

Practice location

6625 S Rural Rd Ste 111
Tempe, AZ 85283-3717

Phone 480-253-9547

Mailing address

15018 N Santiago Pl
Fountain Hills, AZ 85268-1625

Phone 928-368-3645

Authorized official

Katy Christinn Stemple
Owner, Registered Dietitian
9283683645

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