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General NPI Number Information
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NPI Number | 1467180299
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Entity Type | Organization
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Legal Business Name | VITALIZED PERFORMANCE GROUP
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Dates
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Enumeration Date | 08/10/2022
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Last Update Date | 08/10/2022
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Provider Practice Location Address
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Address Line | 212 NEW LONDON TPKE STE D
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City | GLASTONBURY
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State | CT
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Zip | 06033-4202
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Country | US
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Telephone | 860-430-2342
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Fax | 860-430-2342
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Provider Business Mailing Address
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Address Line | 212 NEW LONDON TPKE STE D
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City | GLASTONBURY
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State | CT
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Zip | 06033-4202
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Country | US
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Telephone | 860-430-2342
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GORICA MLADEN-ADDUCI
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Credential |
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Telephone | 917-560-0249
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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