Revitalize Wellness Group Corp

NPI #1730648304 in Wilsonville, Oregon

Provider Information

NPI Number: 1730648304
Entity Type: Organization
Organization Name: Revitalize Wellness Group Corp
Primary Specialty: Naturopath
Enumeration Date: Mar 13, 2019
Last Updated: Mar 13, 2019

Practice Location

Address: 29781 SW TOWN CENTER LOOP W STE 700
City: Wilsonville
State: Oregon
ZIP Code: 97070-8901
Phone: (503) 786-9062

Authorized Official

Name: LORI R DORMAN
Title: PRESIDENT
Phone: (503) 786-9062

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Naturopath	175F00000X	Primary

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