Healthcare Provider Details

I. General information

NPI: 1649706623
Provider Name (Legal Business Name): REVITALIZE HEALTH AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 W ELLIOT RD SUITE 114
GILBERT AZ
85233-5301
US

IV. Provider business mailing address

725 W ELLIOT RD SUITE 114
GILBERT AZ
85233-5301
US

V. Phone/Fax

Practice location:
  • Phone: 480-545-0000
  • Fax:
Mailing address:
  • Phone: 480-545-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8325
License Number StateAZ

VIII. Authorized Official

Name: CURTIS CASADY
Title or Position: OWNER
Credential: DO
Phone: 480-462-2926