REVITALIZE SPINE & SPORTS CARE PLLC NPI 1407430317

NPI Information

NPI: 1407430317
Provider Name: REVITALIZE SPINE & SPORTS CARE PLLC
Classification: Physical Medicine & Rehabilitation - 2081P2900X
Entity Type: Organization

Specialization: Pain Medicine

Address:
4309 W 27TH PL STE 202
KENNEWICK, WA
ZIP 99338
Phone: (509) 591-4966
Get Directions

REVITALIZE SPINE & SPORTS CARE PLLC is a pain medicine physical medicine rehabilitation in Kennewick, WA. The provider is a physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. REVITALIZE SPINE & SPORTS CARE PLLC NPI is 1407430317. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4309 W 27TH PL STE 202
KENNEWICK, WA
ZIP 99338-908
Phone: (509) 591-4966

The provider's authorized official is John Groner .
The authorized official title is Owner / Md and has the following contact phone number (509) 591-4966.

The enumeration date for this NPI number is 5/6/2021 and was last updated on 5/6/2021.

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
1	2081P2900X	Physical Medicine & Rehabilitation	Pain Medicine			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	MD00049437	OTHER	WASHINGTON	WA LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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