Healthcare Provider Details

I. General information

NPI: 1104773266
Provider Name (Legal Business Name): THAT GIRL FIT TGF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25415 SOUTHFIELD RD
SOUTHFIELD MI
48075-1907
US

IV. Provider business mailing address

28475 GREENFIELD RD STE 113
SOUTHFIELD MI
48076-3034
US

V. Phone/Fax

Practice location:
  • Phone: 586-690-5391
  • Fax:
Mailing address:
  • Phone: 231-427-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: VIVIENNE REVIERE
Title or Position: OWNER
Credential: RN
Phone: 586-690-5391