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General NPI Number Information
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NPI Number | 1407656994
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Entity Type | Organization
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Legal Business Name | REVITALIZED HEALTH
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Dates
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Enumeration Date | 03/14/2025
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 1958 PROSPECT ST
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City | SARASOTA
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State | FL
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Zip | 34239-2222
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Country | US
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Telephone | 941-313-2393
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Fax | 904-980-9302
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Provider Business Mailing Address
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Address Line | 1958 PROSPECT ST
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City | SARASOTA
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State | FL
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Zip | 34239-2222
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Country | US
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Telephone | 941-313-2393
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Fax | 904-980-9302
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Authorized Official
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Title or Position | OWNER
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Name | ARUNDATHI RAO
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Credential |
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Telephone | 904-306-6789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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