Organization Name: | THRIVE PEDIATRIC NUTRITION SPECIALISTS, INC |
NPI Number: | 1265889612 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ALI HOWARD ELLIOTT (REGISTERED DIETITIAN) |
Mailing Address: | 200 Office Park Dr Ste 205 Mountain Brk |
State: | AL US |
Postal Code: | 352232455 |
Phone Number: | 2057041641 |
Fax Number: | |
NPI Enumeration Date: | 05/16/2016 |
NPI Last Update Date: | 05/16/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 133VN1004X |
License Number: | 1814 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Dietary & Nutritional Service Providers |
Taxonomy Classification: | Dietitian, Registered |
Taxonomy Specialization: | Nutrition, Pediatric |
Taxonomy Definition: |