REVITALIFE WELLNESS CENTER LLC NPI 1104185685

NPI Information

  • NPI: 1104185685
  • Provider Name: REVITALIFE WELLNESS CENTER LLC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • CLIA Number: 26D2043709
  • Address: 777 S NEW BALLAS RD
    STE 100E
    SAINT LOUIS, MO
    ZIP 63141
  • Phone: (314) 913-5861

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NPI Details

REVITALIFE WELLNESS CENTER LLC is a family medicine in Saint Louis, MO. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. REVITALIFE WELLNESS CENTER LLC NPI is 1104185685. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

777 S NEW BALLAS RD
STE 100E
SAINT LOUIS, MO
ZIP 63141-705
Phone: (314) 913-5861

The provider's authorized official is Christina Robins .
The authorized official title is President and has the following contact phone number (314) 913-5861.

The CLIA number assigned to this NPI record is 26D2043709 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/3/2012 and was last updated on 5/23/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineYes

What is NPI?

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This page was last updated on: 11/21/2025

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