Organization
REVITALIZE WELLNESS GROUP CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI R DORMAN (PRESIDENT)
(503) 786-9062
Entity
Organization
Contact information
Practice address
29781 SW TOWN CENTER LOOP W STE 700, WILSONVILLE, OR 97070-8901
(503) 786-9062
Mailing address
2715 SE MONROE ST, MILWAUKIE, OR 97222-7631
(503) 786-9062
Taxonomy
Speciality
Code
Description
License number
State
175F00000X
Naturopath
Primary
—
—
Other
Enumeration date
03/13/2019
Last updated
03/13/2019
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