Revitalize Wellness Group Corp

Primary specialty

NaturopathTaxonomy code 175F00000X

Legal business name

REVITALIZE WELLNESS GROUP CORP

Practice address

29781 SW Town Center Loop W Ste 700
Wilsonville, OR 97070-8901

Phone

(503) 786-9062

NPI assigned

Mar 13, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lori R Dorman

Title

President

Phone

(503) 786-9062

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1552435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552435200000",
    "number": "1730648304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2715 SE MONROE ST",
            "city": "MILWAUKIE",
            "state": "OR",
            "postal_code": "972227631",
            "telephone_number": "503-786-9062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29781 SW TOWN CENTER LOOP W STE 700",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970708901",
            "telephone_number": "503-786-9062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE WELLNESS GROUP CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-13",
        "last_updated": "2019-03-13",
        "status": "A",
        "authorized_official_last_name": "DORMAN",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-786-9062"
    },
    "taxonomies": [
        {
            "code": "175F00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Naturopath",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan L Reese, D.M.D
• Kendra Hannah Reid, MOT/R
• Rebecca Lauren Reinhardt, OTR/L
• Joseph William Restic, D.M.D.
• Revitalize Health & Wellness LLC
• Lacei Reynolds
• Sarah S Reynolds, OTR/L
• Rha Ventures LLC
• Tiffany Lynn Rhein
• Theresa Riedel

• Naturopath in Wilsonville, OR
• Providers in Wilsonville, OR by specialty
• Naturopath in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.