Provider Demographics
NPI:1972055739
Name:PATTY BERRY RD, LLC
Entity type:Organization
Organization Name:PATTY BERRY RD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CUSTOMER SERVICE LEAD/HEALTHY BYTES
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1844-473-2455
Mailing Address - Street 1:3006 BEE CAVES RD STE D-208
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5588
Mailing Address - Country:US
Mailing Address - Phone:512-375-3210
Mailing Address - Fax:
Practice Address - Street 1:3006 BEE CAVES RD STE D-208
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5588
Practice Address - Country:US
Practice Address - Phone:512-375-3210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty