| Revived Vitality | |
|
1301 48th Ave N # A-2 Myrtle Beach SC 29577-5427 | |
| (843) 580-3694 | |
| Not Available |
| Full Name | Revived Vitality |
|---|---|
| Speciality | Clinic/center |
| Location | 1301 48th Ave N # A-2, Myrtle Beach, South Carolina |
| Authorized Official Name and Position | Jennings Michael Perry (OWNER/PROVIDER) |
| Authorized Official Contact | 8438552299 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revived Vitality 606 Bald Eagle Dr Ste 201 Marco Island FL 34145-2731 Ph: (843) 855-2299 | Revived Vitality 1301 48th Ave N # A-2 Myrtle Beach SC 29577-5427 Ph: (843) 580-3694 |
| NPI Number | 1992588750 |
|---|---|
| Provider Enumeration Date | 08/16/2023 |
| Last Update Date | 08/16/2023 |
| Certification Date | 08/16/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992588750 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (NU) | Primary |
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