Provider Demographics
NPI:1407469893
Name:REIDT, FARRAH MATTHEWS (MHS, RDN, LDN)
Entity Type:Individual
Prefix:MRS
First Name:FARRAH
Middle Name:MATTHEWS
Last Name:REIDT
Suffix:
Gender:F
Credentials:MHS, RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7884 LAURELTON DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1953
Mailing Address - Country:US
Mailing Address - Phone:336-258-7935
Mailing Address - Fax:
Practice Address - Street 1:7884 LAURELTON DR
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1953
Practice Address - Country:US
Practice Address - Phone:336-258-7935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN86074626133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered