| Evolving Vitality LLC | |
|
2143 Burnice Dr Clearwater FL 33764-4859 | |
| (813) 279-9232 | |
| Not Available |
| Full Name | Evolving Vitality LLC |
|---|---|
| Speciality | Clinic/center |
| Location | 2143 Burnice Dr, Clearwater, Florida |
| Authorized Official Name and Position | Chad Robert Daso (CEO) |
| Authorized Official Contact | 8132799232 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evolving Vitality LLC 2143 Burnice Dr Clearwater FL 33764-4859 Ph: (813) 279-9232 | Evolving Vitality LLC 2143 Burnice Dr Clearwater FL 33764-4859 Ph: (813) 279-9232 |
| NPI Number | 1740916170 |
|---|---|
| Provider Enumeration Date | 07/27/2022 |
| Last Update Date | 07/27/2022 |
| Certification Date | 07/27/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740916170 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
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