Provider Demographics
NPI:1265889612
Name:THRIVE PEDIATRIC NUTRITION SPECIALISTS, INC
Entity type:Organization
Organization Name:THRIVE PEDIATRIC NUTRITION SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALI
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LD, CLC
Authorized Official - Phone:205-704-1641
Mailing Address - Street 1:2925 VIRGINIA RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-1253
Mailing Address - Country:US
Mailing Address - Phone:205-704-1641
Mailing Address - Fax:
Practice Address - Street 1:200 OFFICE PARK DR STE 205
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-2455
Practice Address - Country:US
Practice Address - Phone:205-704-1641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1814133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, PediatricGroup - Single Specialty