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General NPI Number Information
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NPI Number | 1891801791
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Entity Type | Organization
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Legal Business Name | MEDICAL NUTRITIONAL THERAPISTS, INC.
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 410 FINZER STREET #302
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City | LOUISVILLE
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State | KY
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Zip | 40203
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Country | US
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Telephone | 800-245-9009
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Fax | 260-489-5057
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Provider Business Mailing Address
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Address Line | 4210 FLAGSTAFF CV
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City | FORT WAYNE
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State | IN
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Zip | 46815-4417
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Country | US
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Telephone | 260-489-9009
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Fax | 260-489-5057
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Authorized Official
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Title or Position | OWNER/VICE PRESIDENT
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Name | JAMES A HOLB
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Credential | RD LD CDE
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Telephone | 260-489-9009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1006X
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Taxonomy Name | Metabolic Nutrition Registered Dietitian
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License Number |
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License Number State |
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