MEDICARE: REVIVE MEDICAL SPA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor		FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AV987A	OTHER	FL	MEDICARE PTAN

General Provider Information

NPI Number	:	1326436049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVIVE MEDICAL SPA LLC

Provider Business Mailing Address
First Line	:	5989 APPROACH RD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34238-5720
Country	:	US
Telephone Number	:	941-921-2225
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 49TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-5237
Country	:	US
Telephone Number	:	727-321-6130
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE OWNER & PROVIDER
Name	:	DR. CHRISTOPHER BRETZ
Credential	:	D.C.
Telephone Number	:	941-921-2225

Provider Enumeration Date	:	01/05/2015
Last Update Date	:	01/05/2015

Similar Medicare Providers

1558334789 — BRYAN PARMER DO
Practice Location Address:

2150 49TH ST N STE A
ST PETERSBURG, FL
33710-5237

Practice Phone: 727-828-1730
Practice Fax: 727-828-1731

1225102577 — TIMOTHY M CYMANSKI DC
Practice Location Address:

2150 49TH ST N STE C
ST PETERSBURG, FL
33710-5237

Practice Phone: 727-327-0721
Practice Fax: 727-327-2875

1992992770 — LATORRE CHIROPRACTIC, INC
Practice Location Address:

2150 49TH ST N , SUITE C
ST PETERSBURG, FL
33710-5237

Practice Phone: 727-321-6130
Practice Fax: 727-327-2677

1942499934 — ANITA LOUISE LENAS LCSW
Practice Location Address:

2150 49TH ST N , SUITE D
ST PETERSBURG, FL
33710-5237

Practice Phone: 727-322-6123
Practice Fax:

1629483698 — NICOLE AGRESTO PSY.D,
Practice Location Address:

2150 49TH ST N STE E
ST PETERSBURG, FL
33710-5237

Practice Phone: 727-685-0934
Practice Fax: 727-279-4986

1427458868 — LWCMDIV, LLC
Practice Location Address:

2150 49TH ST N , SUITE C
SAINT PETERSBURG, FL
33710-5237

Practice Phone: 727-321-6130
Practice Fax: 727-327-2677

Directions to “REVIVE MEDICAL SPA LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.