Healthcare Provider Details

I. General information

NPI: 1154628485
Provider Name (Legal Business Name): EAT AND RUN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2011
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 W PELHAM RD
SHUTESBURY MA
01072-9704
US

IV. Provider business mailing address

PO BOX 95
SHUTESBURY MA
01072-0095
US

V. Phone/Fax

Practice location:
  • Phone: 413-461-8844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000003056
License Number StateMA

VIII. Authorized Official

Name: ELIZABETH R DEVINE
Title or Position: OWNER
Credential: RD, LDN
Phone: 413-461-8844