Healthcare Provider Details

I. General information

NPI: 1255280236
Provider Name (Legal Business Name): AT THE TABLE NUTRITION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 W LANCASTER AVE STE 253
DEVON PA
19333-1592
US

IV. Provider business mailing address

857 COLONY RD
BRYN MAWR PA
19010-1103
US

V. Phone/Fax

Practice location:
  • Phone: 610-615-1055
  • Fax: 610-598-6017
Mailing address:
  • Phone: 516-241-7928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: LISA WILLIAMS
Title or Position: OWNER, REGISTERED DIETIAN
Credential: RD
Phone: 610-615-1055