Organization
REVITALIZE ALABAMA L.L.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRAVIS WOODLEY CRNP (PRESIDENT)
(334) 734-7973
Entity
Organization
Contact information
Practice address
105 1ST STREET, AUBURN, AL 36830-0000
(334) 734-7973
Mailing address
PO BOX 2738, OPELIKA, AL 36803-2738
(334) 734-7973
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
08/10/2021
Last updated
10/06/2021
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