# REVIVED VITALITY

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

## Provider details

- **NPI number:** 1992588750
- **Authorized official:** DR. JENNINGS MICHAEL PERRY DNP (OWNER/PROVIDER)
- **Authorized official phone:** (843) 855-2299

## Contact information

- **Practice address:** 1301 48TH AVE N \# A-2, MYRTLE BEACH, SC 29577-5427
- **Practice address phone:** (843) 580-3694
- **Mailing address:** 606 BALD EAGLE DR STE 201, MARCO ISLAND, FL 34145-2731
- **Mailing address phone:** (843) 855-2299
- **Mailing address fax:** (843) 353-2564

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/16/2023
- **Last updated:** 08/16/2023