Organization
REVIVED VITALITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNINGS MICHAEL PERRY DNP (OWNER/PROVIDER)
(843) 855-2299
Entity
Organization
Contact information
Practice address
1301 48TH AVE N # A-2, MYRTLE BEACH, SC 29577-5427
(843) 580-3694
Mailing address
606 BALD EAGLE DR STE 201, MARCO ISLAND, FL 34145-2731
(843) 855-2299
(843) 353-2564
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
08/16/2023
Last updated
08/16/2023
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