Organization
MEDICAL NUTRITIONAL THERAPISTS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES A HOLB RD LD CDE (OWNER/VICE PRESIDENT)
(260) 489-9009
Entity
Organization
Contact information
Practice address
410 FINZER STREET #302, LOUISVILLE, KY 40203
(800) 245-9009
(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
133VN1006X
Metabolic Nutrition Registered Dietitian
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619919263
NPI
IN
01
—
1972545507
NPI
OH
05
—
2465612
—
OH
Enumeration date
08/22/2006
Last updated
08/22/2020
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