Revitalized, LLC

Primary specialty

Massage TherapistTaxonomy code 225700000X

Legal business name

REVITALIZED, LLC

Practice address

4421 Quail Ridge Dr
Mint Hill, NC 28227-8236

Phone

(704) 800-4980

NPI assigned

May 17, 2022

Organization subpart

No

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

Authorized official

Name

Daniel Fowler

Title

Owner

Phone

(704) 800-4980

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1652745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652745600000",
    "number": "1962149237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4421 QUAIL RIDGE DR",
            "city": "MINT HILL",
            "state": "NC",
            "postal_code": "282278236",
            "telephone_number": "704-800-4980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4421 QUAIL RIDGE DR",
            "city": "MINT HILL",
            "state": "NC",
            "postal_code": "282278236",
            "telephone_number": "704-800-4980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZED, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-17",
        "last_updated": "2022-05-17",
        "certification_date": "2022-05-17",
        "status": "A",
        "authorized_official_last_name": "FOWLER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-800-4980"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2022; 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.