Organization
WHOLISTIC REVOLUTION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH WALTER POUCKET (OWNER)
(734) 558-6532
Entity
Organization
Contact information
Practice address
4076 BIDDLE AVE, WYANDOTTE, MI 48192-7116
(734) 558-6532
Mailing address
4076 BIDDLE AVE, WYANDOTTE, MI 48192-7116
(734) 558-6532
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
03/01/2022
Last updated
03/01/2022
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