REVITALIZE WELLNESS GROUP CORP (NPI# 1730648304) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730648304 |
| Entity Type | Organization |
| Organization Name | REVITALIZE WELLNESS GROUP CORP |
| Practice Address |
29781 Sw Town Center Loop W Ste 700 Wilsonville OR 97070-8901 |
| Mailing Address |
2715 Se Monroe St Milwaukie OR 97222-7631 |
| Practice Telephone | 5037869062 |
| Mailing Telephone | 5037869062 |
| Enumeration Date | 2019-03-13 |
| Last Update Date | 2019-03-13 |
| Authorized Official Name | LORI R DORMAN (PRESIDENT) |
| Authorized Official Telephone | 5037869062 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175F00000X | Naturopath | Other Service Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | REVITALIZE WELLNESS GROUP CORP. | 29781 Town Center Loop West #700, Wilsonville, OR 97070 |
| Street Address |
29781 SW TOWN CENTER LOOP W STE 700 |
| City | WILSONVILLE |
| State | OR |
| Zip Code | 97070-8901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386017820 | Amy Mcduffee | Naturopath | 29781 Sw Town Center Loop W Ste 700, Wilsonville, OR 97070-8901 | 2015-11-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457995896 | Rosalyn Sharon Mckinney | Technician | 7798 Sw Vlahos Dr, Wilsonville, OR 97070 | 2019-10-29 |
| 1275027393 | Oregon Regeneration Stem Cell Medical Center, LLC | Chiropractor | 29781 Sw Town Center Loop, Wilsonville, OR 97070 | 2018-06-21 |
| 1073050472 | Kirstin Marie Lauritzen | Chiropractor | 25589 Sw Canyon Creek Rd Ste 100, Wilsonville, OR 97070 | 2017-01-23 |
| 1932642220 | Nicole Galasso | Occupational Therapy Assistant | 25117 Sw Parkway Avenue Suite D, Wilsonville, OR 97070 | 2016-11-18 |
| 1508317512 | Justin Langlais | Naturopath | 25195 Sw Parkway Ave Ste 210, Wilsonville, OR 97070 | 2016-10-14 |
| 1518411149 | Stephanie Tran | Optometrist | 29250 Town Center Loop W, Wilsonville, OR 97070 | 2016-08-11 |
| 1346610607 | Rachel Ziegler | Occupational Therapy Assistant | 25117 Sw Parkway Ave Suite D, Willsonville, OR 97070 | 2015-09-30 |
| 1992184238 | Michelle Miranda | Counselor | 30150 Sw Parkway Ave Ste 300, Wilsonville, OR 97070 | 2015-05-19 |
| 1609275007 | Ryan Bridges | Dentist | 30040 Sw Boones Ferry Rd Ste 20, Wilsonville, OR 97070 | 2014-08-21 |
| 1649604018 | Jason Russell James | Physical Therapist | 29174 Sw Town Center Loop W # 202b, Wilsonville, OR 97070 | 2013-08-21 |
| Find all providers in zip 97070 | ||||
| Taxonomy Code | 175F00000X |
| Grouping | Other Service Providers |
| Classification | Naturopath |
| Diagnoses, treats, and cares for patients, using system of practice that bases treatment of physiological functions and abnormal conditions on natural laws governing human body: Utilizes physiological, psychological, and mechanical methods, such as air, water, light, heat, earth, phototherapy, food and herb therapy, psychotherapy, electrotherapy, physiotherapy, minor and orificial surgery, mechanotherapy, naturopathic corrections and manipulation, and natural methods or modalities, together with natural medicines, natural processed foods, and herbs and nature's remedies. Excludes major surgery, therapeutic use of x ray and radium, and use of drugs, except those assimilable substances containing elements or compounds which are components of body tissues and are physiologically compatible to body processes for maintenance of life. |
| Notes: Source: The Federal Dictionary of Occupational Titles, U.S. Department of Labor, Washington, D.C., section #079, 101-014 [7/1/2007: definition changed, source added] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508317512 | Justin Langlais | Naturopath | 25195 Sw Parkway Ave Ste 210, Wilsonville, OR 97070 | 2016-10-14 |
| 1386017820 | Amy Mcduffee | Naturopath | 29781 Sw Town Center Loop W Ste 700, Wilsonville, OR 97070-8901 | 2015-11-05 |
| 1659616076 | Kristie F Ritchey | Naturopath | 29781 Sw Town Center Loop W Ste 500, Wilsonville, OR 97070 | 2012-12-11 |
| 1760736128 | Dr. Jennifer E. Bogus | Naturopath | 29020 Sw Town Center Loop E, Suite 100, Wilsonville, OR 97070-9489 | 2012-11-06 |
| 1497020754 | Misty Mcdowell | Naturopath | 7194 Sw Mcdonald Dr, #107, Wilsonville, OR 97070-6520 | 2012-03-19 |
| 1376103275 | Pacifica Healthcare, LLC | Naturopath | 25195 Sw Parkway Ave Ste 210, Wilsonville, OR 97070-9689 | 2019-06-13 |
| 1679139778 | Revitalize Health & Wellness, LLC | Naturopath | 29781 Sw Town Center Loop W Ste 500, Wilsonville, OR 97070-8903 | 2019-05-14 |
| 1467816405 | April Voves | Naturopath | 30485 Sw Boones Ferry Rd Ste 104, Wilsonville, OR 97070-7845 | 2016-04-06 |
| 1215365630 | Elizabeth C Sedlak | Naturopath | 25195 Sw Parkway Ave, Suite 210, Wilsonville, OR 97070-9651 | 2013-10-22 |
| 1235376831 | Lee Samatowic | Naturopath | 8600 Sw Salish Ln, Suite One, Wilsonville, OR 97070-9632 | 2009-01-19 |
| Find all providers in WILSONVILLE | ||||
| City | WILSONVILLE |
| Zip Code | 97070 |
Please comment or provide details below to improve the information on REVITALIZE WELLNESS GROUP CORP.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.