Provider Demographics
NPI:1235650011
Name:PUSH NUTRITION COACHING, LLC
Entity Type:Organization
Organization Name:PUSH NUTRITION COACHING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NUTRITION SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SPELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RD, LDN, CDOE
Authorized Official - Phone:401-610-0301
Mailing Address - Street 1:6 GRANDVIEW ST
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-4116
Mailing Address - Country:US
Mailing Address - Phone:401-610-0301
Mailing Address - Fax:
Practice Address - Street 1:6 GRANDVIEW ST
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-4116
Practice Address - Country:US
Practice Address - Phone:401-473-7644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILDN00118133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty