Organization
REVIVOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER PATRICK KELLY M.D. (MEDICAL DIRECTOR/OWNER)
(801) 987-8653
Entity
Organization
Contact information
Practice address
11464 S PARKWAY PLAZA DR, SUITE 300, SOUTH JORDAN, UT 84095-6052
(801) 987-8653
(801) 727-8177
Mailing address
11464 S PARKWAY PLAZA DR, SUITE 300, SOUTH JORDAN, UT 84095-6052
(801) 987-8653
(801) 727-8177
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
9258138-1205
UT
Other
Enumeration date
05/04/2017
Last updated
05/04/2017
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