Organization
REVIVE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BREKE EWTON (RESIDENT PRACTITIONER)
(970) 682-2038
Entity
Organization
Contact information
Practice address
2601 S LEMAY AVE, SUITE 35, FORT COLLINS, CO 80525-2295
(970) 682-2038
(970) 682-2592
Mailing address
2601 S LEMAY AVE, SUITE 35, FORT COLLINS, CO 80525-2295
(970) 682-2038
(970) 682-2592
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0016731
CO
Other
Enumeration date
08/23/2014
Last updated
08/23/2014
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