Provider Demographics
NPI:1073201133
Name:NUTRITION THERAPY SERVICES, INC
Entity Type:Organization
Organization Name:NUTRITION THERAPY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:WENDI
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:704-619-7545
Mailing Address - Street 1:5734 TIPPERARY DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-7581
Mailing Address - Country:US
Mailing Address - Phone:704-740-5681
Mailing Address - Fax:
Practice Address - Street 1:4688 MOUNTAIN CREEK AVE STE 102
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-6803
Practice Address - Country:US
Practice Address - Phone:704-619-7545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty