Healthcare Provider Details

I. General information

NPI: 1568183069
Provider Name (Legal Business Name): INTEGRAVITA WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 09/05/2022
Certification Date: 09/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 FORDING ISLAND RD STE 102
BLUFFTON SC
29910-6506
US

IV. Provider business mailing address

1127 FORDING ISLAND RD STE 102
BLUFFTON SC
29910-6506
US

V. Phone/Fax

Practice location:
  • Phone: 843-962-6855
  • Fax: 843-962-6268
Mailing address:
  • Phone: 843-962-6855
  • Fax: 843-962-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADLEY C MORRIS
Title or Position: CEO
Credential: DC
Phone: 843-683-2100