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General NPI Number Information
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NPI Number | 1659244143
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Entity Type | Organization
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Legal Business Name | REVIVIFY BEAUTY SALON & SPA, LLC
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 5041 EDGEWATER DR
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City | ORLANDO
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State | FL
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Zip | 32810-5226
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Country | US
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Telephone | 407-205-9393
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Fax | 407-201-4460
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Provider Business Mailing Address
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Address Line | 1600 THE OAKS BLVD
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City | KISSIMMEE
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State | FL
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Zip | 34746-3829
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Country | US
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Telephone | 407-577-8136
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Fax | 407-201-4460
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Authorized Official
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Title or Position | OWNER
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Name | ABIGAIL AZALEA RICE
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Credential |
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Telephone | 407-205-9393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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