Provider Demographics
NPI:1538860689
Name:YOUR VITALITY, LLC
Entity type:Organization
Organization Name:YOUR VITALITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-440-8494
Mailing Address - Street 1:2532 N 4TH ST # 278
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-3712
Mailing Address - Country:US
Mailing Address - Phone:602-999-9974
Mailing Address - Fax:
Practice Address - Street 1:2717 N 4TH ST STE 120
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1813
Practice Address - Country:US
Practice Address - Phone:928-440-8494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty