| NPI | 1275280943 |
|---|---|
| Former Legal Business Name | REVIVE BODYWORKS CORP |
| Entity Type | Organization |
| Authorized Contact | PAULA KOLANO Owner 631-943-1243 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225700000X Massage Therapist |
| Enumeration Date | 2022-03-03 |
| Last Update Date | 2022-03-03 |