# REVITALIZE SPINE & SPORTS CARE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407430317
- **Authorized official:** JOHN GRONER MD (OWNER / MD)
- **Authorized official phone:** (509) 591-4966

## Contact information

- **Practice address:** 4309 W 27TH PL STE 202, KENNEWICK, WA 99338-2908
- **Practice address phone:** (509) 591-4966
- **Mailing address:** 4309 W 27TH PL STE 202, KENNEWICK, WA 99338-2908

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/06/2021
- **Last updated:** 05/06/2021