Provider Demographics
NPI:1407656994
Name:REVITALIZED HEALTH
Entity type:Organization
Organization Name:REVITALIZED HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARUNDATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-306-6789
Mailing Address - Street 1:1958 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2222
Mailing Address - Country:US
Mailing Address - Phone:941-313-2393
Mailing Address - Fax:904-980-9302
Practice Address - Street 1:1958 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2222
Practice Address - Country:US
Practice Address - Phone:941-313-2393
Practice Address - Fax:904-980-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty