NPIMap

Organization Active NPI

Full Stride Wellness

  • Registered Dietitian
  • Reisterstown, MD
National Provider Identifier
1992105548
Registry record updated Sep 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
License
DX3643 Issued in MD
Legal business name
FULL STRIDE WELLNESS
Practice address
100 Business Center Dr
Reisterstown, MD 21136-1229
Phone
(410) 833-0503
NPI assigned
Sep 2, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2014

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

Authorized official

Name
Ms. Jennifer Cook, ATC, LAT
Title
Owner
Phone
(410) 833-0503

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered DietitianGroup: 193400000X SINGLE SPECIALTY GROUP 133V00000X DX3643 MD Primary

Addresses

Primary practice location

100 Business Center Dr
Reisterstown, MD 21136-1229

Mailing address

100 Business Center Dr
Reisterstown, MD 21136-1229
Phone (410) 833-0503

National Provider Directory

National Provider Directory

Locations

100 Business Center Dr
Reisterstown, MD 21136
Phone (410) 833-0503

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1409616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409616000000",
    "number": "1992105548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BUSINESS CENTER DR",
            "city": "REISTERSTOWN",
            "state": "MD",
            "postal_code": "211361229",
            "telephone_number": "410-833-0503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BUSINESS CENTER DR",
            "city": "REISTERSTOWN",
            "state": "MD",
            "postal_code": "211361229",
            "telephone_number": "410-833-0503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL STRIDE WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-02",
        "last_updated": "2014-09-02",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-833-0503",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "ATC, LAT"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "MD",
            "license": "DX3643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reisterstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2014; 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.