Organization
REVITALIZE SPINE & SPORTS CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN GRONER MD (OWNER / MD)
(509) 591-4966
Entity
Organization
Contact information
Practice address
4309 W 27TH PL STE 202, KENNEWICK, WA 99338-2908
(509) 591-4966
Mailing address
4309 W 27TH PL STE 202, KENNEWICK, WA 99338-2908
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD00049437
WA LICENSE
WA
Enumeration date
05/06/2021
Last updated
05/06/2021
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