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Organization
BETWEEN THE LINES REJUVENATION LLC
Active
Organization
BETWEEN THE LINES REJUVENATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTA CORBETT NP (OWNER)
(801) 694-1197
Entity
Organization
Contact information
Practice address
1785 E WILSON AVE, SALT LAKE CITY, UT 84108-2916
(877) 258-6331
(718) 362-1651
Mailing address
612 CORPORATE WAY STE 2M, VALLEY COTTAGE, NY 10989-2027
(718) 362-1411
(718) 362-1651
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
NULL
Other
Enumeration date
01/29/2024
Last updated
07/17/2024
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