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General NPI Number Information
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NPI Number | 1609559384
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Entity Type | Organization
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Legal Business Name | BALANCED NUTRITION THERAPY, LLC
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Dates
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Enumeration Date | 08/09/2023
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 50 CRESTWOOD EXECUTIVE CTR STE 500
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City | SAINT LOUIS
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State | MO
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Zip | 63126-1948
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Country | US
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Telephone | 636-686-0682
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Fax |
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Provider Business Mailing Address
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Address Line | 529 VISTA HILLS CT
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City | EUREKA
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State | MO
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Zip | 63025-3605
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIETITIAN
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Name | REBECCA ADAMS
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Credential | RD
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Telephone | 636-686-0682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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