Provider Demographics
NPI:1275047755
Name:ALT PERFORMANCE NUTRITION, LLC
Entity Type:Organization
Organization Name:ALT PERFORMANCE NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISOPN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:TROPF
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, CSSD
Authorized Official - Phone:517-775-5008
Mailing Address - Street 1:6690 ABERDEEN DR
Mailing Address - Street 2:
Mailing Address - City:DIMONDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48821-9504
Mailing Address - Country:US
Mailing Address - Phone:517-775-5008
Mailing Address - Fax:
Practice Address - Street 1:115 W ALLEGAN ST STE 700
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48933-1751
Practice Address - Country:US
Practice Address - Phone:517-775-5008
Practice Address - Fax:302-371-8064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1034794133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty