Organization
WESTERN RACQUET & FITNESS CLUB INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAD J TAGGART RDN, CD (REGISTERED DIETITIAN, DIRECTOR)
(920) 246-4886
Entity
Organization
Contact information
Practice address
2500 S ASHLAND AVE, GREEN BAY, WI 54304-5252
(920) 497-1611
Mailing address
2500 S ASHLAND AVE, GREEN BAY, WI 54304-5252
(920) 497-1611
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
05/07/2024
Last updated
05/07/2024
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