Organization
REVIVE INJURY & WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHANEL LYNN BALAJADIA (OWNER/CFO)
(725) 216-7859
Entity
Organization
Contact information
Practice address
2931 N TENAYA WAY STE 204, LAS VEGAS, NV 89128-0458
(725) 216-7859
(725) 216-7859
Mailing address
2931 N TENAYA WAY STE 204, LAS VEGAS, NV 89128-0458
(725) 216-7859
(725) 216-7859
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
09/02/2022
Last updated
09/02/2022
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