Organization
KB MEDICAL NUTRITION THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHRYN LEIGH BALKUNAS (OWNER)
(860) 484-9808
Entity
Organization
Contact information
Practice address
500 BURLINGTON RD, HARWINTON, CT 06791-1506
(860) 485-0405
Mailing address
197 JOHNNYCAKE MOUNTAIN RD, BURLINGTON, CT 06013-2011
(860) 484-9808
Taxonomy
Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001637
LICENSE
CT
Enumeration date
11/15/2018
Last updated
11/15/2018
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