Healthcare Provider Details

I. General information

NPI: 1164344537
Provider Name (Legal Business Name): VITALITY POWELL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3751 ATTUCKS DR
POWELL OH
43065-6080
US

IV. Provider business mailing address

3751 ATTUCKS DR
POWELL OH
43065-6080
US

V. Phone/Fax

Practice location:
  • Phone: 614-717-1767
  • Fax: 866-682-2412
Mailing address:
  • Phone: 614-717-1767
  • Fax: 866-682-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA MCRAE
Title or Position: CEO/OWNER
Credential: DO
Phone: 419-989-4342