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General NPI Number Information
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NPI Number | 1790530145
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Entity Type | Organization
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Legal Business Name | VITAL WELLNESS, LLC
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Dates
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Enumeration Date | 04/19/2024
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Last Update Date | 01/09/2025
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Provider Practice Location Address
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Address Line | 321 AUTUMN RIVER RUN
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City | PHILADELPHIA
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State | PA
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Zip | 19128-4355
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Country | US
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Telephone | 267-908-4825
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Fax | 267-955-9935
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Provider Business Mailing Address
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Address Line | 701 E. CATHEDRAL RD. SUITE 45-1483
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City | PHILADELPHIA
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State | PA
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Zip | 19128-2128
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Country | US
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Telephone | 267-908-4825
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Fax | 267-955-9935
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Authorized Official
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Title or Position | FOUNDER & CEO
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Name | AMANDA HOLLENBACH
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Credential | MS,RD,LDN,LAT,ATC
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Telephone | 267-908-4825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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