Revive Clinic and IV Therapy LLC

NPI #1578249942 in Burke, Virginia

Provider Information

NPI Number: 1578249942
Entity Type: Organization
Organization Name: Revive Clinic and IV Therapy LLC
Primary Specialty: Family Medicine
Enumeration Date: Jun 22, 2023
Last Updated: Sep 19, 2023

Practice Location

Address: 5631 BURKE CENTRE PKWY STE C
City: Burke
State: Virginia
ZIP Code: 22015-2234
Phone: (703) 200-1015

Authorized Official

Name: MICHELLE BUTLER
Title: AUTHORIZED OFFICIAL
Phone: (916) 909-4910

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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