Organization
THE FRESH BEET NUTRITION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY G THOMAS MS, RD (REGISTERED DIETITIAN/OWNER)
(843) 410-8233
Entity
Organization
Contact information
Practice address
1609 W MOSS AVE, PEORIA, IL 61606-1642
(843) 410-8233
Mailing address
1609 W MOSS AVE, PEORIA, IL 61606-1642
(843) 410-8233
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DT1129
—
SC
Enumeration date
01/15/2019
Last updated
01/15/2019
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