Provider Demographics
NPI:1649706623
Name:REVITALIZE HEALTH AND WELLNESS PLLC
Entity type:Organization
Organization Name:REVITALIZE HEALTH AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CASADY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-462-2926
Mailing Address - Street 1:725 W ELLIOT RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5301
Mailing Address - Country:US
Mailing Address - Phone:480-545-0000
Mailing Address - Fax:
Practice Address - Street 1:725 W ELLIOT RD
Practice Address - Street 2:SUITE 114
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5301
Practice Address - Country:US
Practice Address - Phone:480-545-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X, 333600000X
AZ8325111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No333600000XSuppliersPharmacyGroup - Multi-Specialty