Revivify Beauty Salon & Spa, LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

REVIVIFY BEAUTY SALON & SPA, LLC

Practice address

5041 Edgewater Dr
Orlando, FL 32810-5226

Phone

(407) 205-9393

Fax

(407) 201-4460

NPI assigned

Sep 29, 2025

Organization subpart

No

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

Authorized official

Name

Abigail Azalea Rice

Title

Owner

Phone

(407) 205-9393

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1759104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759104000000",
    "number": "1659244143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 THE OAKS BLVD",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347463829",
            "telephone_number": "407-577-8136",
            "fax_number": "407-201-4460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5041 EDGEWATER DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328105226",
            "telephone_number": "407-205-9393",
            "fax_number": "407-201-4460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVIFY BEAUTY SALON & SPA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-29",
        "last_updated": "2025-09-29",
        "certification_date": "2025-09-29",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "ABIGAIL",
        "authorized_official_middle_name": "AZALEA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-205-9393"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Orlando, FL
• Providers in Orlando, FL by specialty
• Prosthetic/Orthotic Supplier in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.