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General NPI Number Information
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NPI Number | 1598560575
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Entity Type | Organization
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Legal Business Name | REDEFYNE- SKIN & BODY REVIVAL
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 875 E NINE MILE RD STE 6
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City | PENSACOLA
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State | FL
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Zip | 32514-1708
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Country | US
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Telephone | 850-542-7413
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Fax |
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Provider Business Mailing Address
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Address Line | 875 E NINE MILE RD STE 6
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City | PENSACOLA
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State | FL
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Zip | 32514-1708
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Country | US
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Telephone | 850-542-7413
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN PHAM
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Credential | NP
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Telephone | 850-207-4063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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