Basic Information
| Provider Information | |||||||||
| NPI: | 1306069489 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FUELING PERFORMANCE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 ADDISON ALCOVE | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551298539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122421391 | ||||||||
| FaxNumber: | 6519980836 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 SMITH AVE N STE 301 | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551022534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512885180 | ||||||||
| FaxNumber: | 6512885188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ZEHETNER | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | WAYNE | ||||||||
| AuthorizedOfficialTitleorPosition: | NUTRITION CONSULTANT | ||||||||
| AuthorizedOfficialTelephone: | 6122421391 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MS,RD,CSCS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 2214 | MN | Y | 193400000X SINGLE SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.