Organization
REVIVE CLINIC AND IV THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE BUTLER (AUTHORIZED OFFICIAL)
(916) 909-4910
Entity
Organization
Contact information
Practice address
5631 BURKE CENTRE PKWY STE C, BURKE, VA 22015-2234
(703) 200-1015
Mailing address
5631 BURKE CENTRE PKWY STE C, BURKE, VA 22015-2234
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
06/22/2023
Last updated
09/19/2023
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