Organization
FUNCTIONAL WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI MATHEWS LD (OWNER)
(405) 277-0144
Entity
Organization
Contact information
Practice address
1611 N BROADWAY AVE, OKLAHOMA CITY, OK 73103-4610
(405) 277-0144
Mailing address
1 NE 2ND ST APT 401, OKLAHOMA CITY, OK 73104-2236
(405) 277-0144
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
03/31/2023
Last updated
03/31/2023
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