MEDICARE: VITALITY HEALTH TECHNOLOGIES

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1396502514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALITY HEALTH TECHNOLOGIES

Provider Business Mailing Address
First Line	:	401 LANTANA RD STE 10
Second Line	:
City	:	LANTANA
State	:	FL
Zip	:	33462-1725
Country	:	US
Telephone Number	:	888-808-8357
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 LANTANA RD STE 10
Second Line	:
City	:	LANTANA
State	:	FL
Zip	:	33462-1725
Country	:	US
Telephone Number	:	888-808-8357
Fax Number	:

Authorized Official
Title or Position	:	MNGR
Name	:	MR. STEPHENSON JEROME
Credential	:
Telephone Number	:	888-808-8357

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	10/04/2024

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