Organization
MEDICAL NUTRITIONAL THERAPISTS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES A HOLB RD,LD,CDE (VICE PRESIDENT/OWNER)
(260) 489-9009
Entity
Organization
Contact information
Practice address
4210 FLAGSTAFF CV, FORT WAYNE, IN 46815-4417
(260) 489-9009
(260) 489-5057
Mailing address
4210 FLAGSTAFF CV, FORT WAYNE, IN 46815-4417
(260) 489-9009
(260) 489-5057
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2465612
—
OH
Enumeration date
06/11/2006
Last updated
07/21/2022
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