Organization
SOUTHLAKE FOOT & WELLNESS CENTER LLC
Active
Other names
Vitality Wellness Clinic, Vitality Wellness Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
VITALITY WELLNESS CLINIC (OWNER)
(817) 527-6077
Entity
Organization
Contact information
Practice address
6407 COLLEYVILLE BLVD STE B, COLLEYVILLE, TX 76034-6279
(817) 527-6077
(817) 796-1694
Mailing address
901 W WALL ST STE 103, GRAPEVINE, TX 76051-7419
(817) 527-6077
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
AC00108
TX
Other
Enumeration date
03/15/2018
Last updated
10/05/2023
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