Organization
REVITALIZED, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL FOWLER (OWNER)
(704) 800-4980
Entity
Organization
Contact information
Practice address
4421 QUAIL RIDGE DR, MINT HILL, NC 28227-8236
(704) 800-4980
Mailing address
4421 QUAIL RIDGE DR, MINT HILL, NC 28227-8236
(704) 800-4980
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
05/17/2022
Last updated
05/17/2022
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