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REVITALIZE SPINE & SPORTS CARE, PLLC

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Company Details

Legal Name: REVITALIZE SPINE & SPORTS CARE, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: March 18th 2021
Expiration date: 31 Mar 2026
UBI Number: 604 729 944
ZIP code: 99338
City: Kennewick
County: BENTON
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 4309 W 27TH PL, SUITE 202, KENNEWICK, WA, 99338-2904, UNITED STATES

Contact Details

E-Mail: BVOLMER@POWELLANDGUNTER.COM
Phone Number: +1 509-943-6781

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role Address
JOHN GRONER Registered Agent 4309 W 27TH PL, SUITE 202, KENNEWICK, WA, 99338-2904, UNITED STATES

Key Officers & Management

Name Role Address
JOHN GRONER Executor 3747 S MCKINLEY ST, KENNEWICK, WA, 99338-1501, UNITED STATES
JOHN GRONER Governing Person -

National Provider Identifier

NPI Number:
1407430317
Certification Date:
2021-05-06

Authorized Person:

Name:
JOHN GRONER
Role:
OWNER / MD
Phone:

Taxonomy:

Selected Taxonomy:
2081P2900X - Pain Medicine (Physical Medicine & Rehabilitation) Physician
Is Primary:
Yes

Contacts:

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