Provider Demographics
NPI:1447829833
Name:NUTRITIONAL YOGA THERAPY
Entity type:Organization
Organization Name:NUTRITIONAL YOGA THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:DESMARAIS
Authorized Official - Suffix:
Authorized Official - Credentials:HEALTH COAC
Authorized Official - Phone:617-913-0531
Mailing Address - Street 1:44 HAMLET ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-3226
Mailing Address - Country:US
Mailing Address - Phone:617-913-0531
Mailing Address - Fax:
Practice Address - Street 1:44 HAMLET ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-3226
Practice Address - Country:US
Practice Address - Phone:617-913-0531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date: