# VITAGLIDE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** VitaGlide, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023743879
- **Authorized official:** MARCELYN SUE ULLOM (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (305) 514-0514

## Contact information

- **Practice address:** 419 HAWK ST, ROCKLEDGE, FL 32955-3291
- **Practice address phone:** (305) 514-0514
- **Mailing address:** 2445 RIVERVIEW DR NE, PALM BAY, FL 32905-2515
- **Mailing address phone:** (305) 586-2250

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 07/17/2022
- **Last updated:** 07/17/2022