Revive Body & Skin LLC

Primary specialty

Other Specialist/TechnologistTaxonomy code 246Z00000X

Legal business name

REVIVE BODY & SKIN LLC

Practice address

635 W Summit Ave
Norton Shores, MI 49441-4190

Phone

(407) 982-4876

Fax

(407) 650-2754

NPI assigned

Sep 8, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Hadley WhitakerNPI 1033099130

Title

Owner

Phone

(407) 982-4876

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Hadley Whitaker

  • Other Specialist/Technologist
  • Norton Shores, MI
  • NPI 1033099130

  Single Specialty

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1757289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757289600000",
    "number": "1346120458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7575 DR PHILLIPS BLVD STE 155",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328197220",
            "telephone_number": "407-982-4876",
            "fax_number": "407-650-2754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 W SUMMIT AVE",
            "city": "NORTON SHORES",
            "state": "MI",
            "postal_code": "494414190",
            "telephone_number": "407-982-4876",
            "fax_number": "407-650-2754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE BODY & SKIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-08",
        "last_updated": "2025-09-08",
        "certification_date": "2025-09-08",
        "status": "A",
        "authorized_official_last_name": "WHITAKER",
        "authorized_official_first_name": "HADLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-982-4876"
    },
    "taxonomies": [
        {
            "code": "246Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Other",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Reed, BCBA
• Mark Reider
• Renae L Crozier
• Resurging Pathways Collective LLC
• Emily Retzlaff, LM, CPM
• Jeffrey S Rewitzer, D.P.M.
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• Todd W Rexford, MD
• Madison R Reynen
• Luke F Reynolds, LMSW

• Other Specialist/Technologist in Norton Shores, MI
• Providers in Norton Shores, MI by specialty
• Other Specialist/Technologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.