Healthcare Provider Details

I. General information

NPI: 1134513641
Provider Name (Legal Business Name): TIM KNOPP NUTRITIONIST/TRAINER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

938 WISTERIA DR
LOVELAND CO
80538-4647
US

IV. Provider business mailing address

938 WISTERIA DR
LOVELAND CO
80538-4647
US

V. Phone/Fax

Practice location:
  • Phone: 970-420-4987
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: