| Rejuvenation Medspa | |
|
1400 Johnson Ave Ste 4a Bridgeport WV 26330-1063 | |
| (304) 848-9998 | |
| (304) 848-9996 |
| Full Name | Rejuvenation Medspa |
|---|---|
| Speciality | Family Medicine |
| Location | 1400 Johnson Ave Ste 4a, Bridgeport, West Virginia |
| Authorized Official Name and Position | Timothy Michael Peasak (OWNER/PROVIDER) |
| Authorized Official Contact | 3048411293 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rejuvenation Medspa 1400 Johnson Ave Ste 4a Bridgeport WV 26330-1063 Ph: (304) 848-9998 | Rejuvenation Medspa 1400 Johnson Ave Ste 4a Bridgeport WV 26330-1063 Ph: (304) 848-9998 |
| NPI Number | 1780158287 |
|---|---|
| Provider Enumeration Date | 01/17/2019 |
| Last Update Date | 01/17/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780158287 | NPI | - | NPPES |
| 1942 | Other | WV | WV LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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