Organization
REVITALIZE PAIN AND SPINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY WILLIAMS (DIRECTOR)
(480) 969-4040
Entity
Organization
Contact information
Practice address
4838 E BASELINE RD STE 110, MESA, AZ 85206-4674
(480) 210-2641
(480) 210-2642
Mailing address
4838 E BASELINE RD STE 110, MESA, AZ 85206-4674
(480) 210-2641
(480) 210-2642
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
208VP0000X
Pain Medicine Physician
Primary
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
10/14/2020
Last updated
10/14/2020
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