Deer Lake Lodge, LLC

NPI #1922769231 in Montgomery, Texas

Provider Information

NPI Number: 1922769231
Entity Type: Organization
Organization Name: Deer Lake Lodge, LLC
Primary Specialty: Nutritionist
Enumeration Date: Jan 8, 2022
Last Updated: Jan 8, 2022

Practice Location

Address: 10500 DEER LAKE LODGE RD
City: Montgomery
State: Texas
ZIP Code: 77316-9604
Phone: (281) 414-5111

Authorized Official

Name: TRACY BOULWARE
Title: SPA & WELLNESS DIRECTOR
Phone: (281) 414-5111

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Nutritionist	133N00000X	Primary

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