Fountain Life Dallas, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

FOUNTAIN LIFE DALLAS, LLC

Doing business as

Fountain Life Orlando, LLLC

Practice address

5762 Grandscape Blvd Ste 115
The Colony, TX 75056-6782

Phone

(469) 669-0336

NPI assigned

Jul 21, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Barbara Woo

Title

Director of Clinical Operations

Phone

(917) 810-8672

Specialties & licenses 1

Addresses

Other names 1

• Fountain Life Orlando, LLLC Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689897600000",
    "number": "1336829514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5762 GRANDSCAPE BLVD STE 115",
            "city": "THE COLONY",
            "state": "TX",
            "postal_code": "750566782",
            "telephone_number": "469-669-0336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5762 GRANDSCAPE BLVD STE 115",
            "city": "THE COLONY",
            "state": "TX",
            "postal_code": "750566782",
            "telephone_number": "469-669-0336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN LIFE DALLAS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-21",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A",
        "authorized_official_last_name": "WOO",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL OPERATIONS",
        "authorized_official_telephone_number": "917-810-8672"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fountain Life Orlando, LLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melissa Fletcher, MS, LPC
• FMS Elite LLC
• Letitia Ford, RPH
• Morgan Foster
• Foundational Wellness, PC
• Frank T Felts, MD, Facs, PA
• Joey Frare, LAT
• Michelle Fridman, SLP-INTERN
• Carlos X Galindo, MD
• Rhonda Corbell Gayle, OTR

• Clinic/Center in The Colony, TX
• Providers in The Colony, TX by specialty
• Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.