Healthcare Provider Details

I. General information

NPI: 1629897467
Provider Name (Legal Business Name): VITALITY HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6988 LEBANON RD STE 101
FRISCO TX
75034-6743
US

IV. Provider business mailing address

6988 LEBANON RD STE 101
FRISCO TX
75034-6743
US

V. Phone/Fax

Practice location:
  • Phone: 469-323-0033
  • Fax: 214-446-5304
Mailing address:
  • Phone: 469-323-0033
  • Fax: 214-446-5304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MATT CHALMERS
Title or Position: PRESIDENT
Credential:
Phone: 469-323-0033