# FUNCTIONAL HEALTH REVOLUTION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396521134
- **Authorized official:** KIM SEIDL (MEMBER)
- **Authorized official phone:** (703) 214-5121

## Contact information

- **Practice address:** 4445 CORPORATION LN STE 264, VIRGINIA BEACH, VA 23462-3671
- **Practice address phone:** (703) 214-5121
- **Mailing address:** 3301 RICHMOND HWY \# 1127, ALEXANDRIA, VA 22305-3044
- **Mailing address phone:** (703) 214-5121

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171400000X | Health & Wellness Coach | — | NULL | Yes |
| 171400000X | Health & Wellness Coach | — | — | Yes |

## Other

- **Enumeration date:** 09/07/2023
- **Last updated:** 11/22/2024