# REVITALIZE 3D

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568139269
- **Authorized official:** DR. BRIAN PATRICK COLLINS DPT (OWNER/CEO)
- **Authorized official phone:** (785) 477-2647

## Contact information

- **Practice address:** 184 W 400 N, PROVO, UT 84601-2855
- **Practice address phone:** (785) 477-2647
- **Mailing address:** 1427 S 680 W, PROVO, UT 84601-5544
- **Mailing address phone:** (785) 477-2647

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |
| 2251E1200X | Ergonomics Physical Therapist | — | NULL | — |
| 2251E1200X | Ergonomics Physical Therapist | — | — | — |
| 2251G0304X | Geriatric Physical Therapist | — | NULL | — |
| 2251G0304X | Geriatric Physical Therapist | — | — | — |
| 2251H1300X | Human Factors Physical Therapist | — | NULL | — |
| 2251H1300X | Human Factors Physical Therapist | — | — | — |
| 2251S0007X | Sports Physical Therapist | — | NULL | — |
| 2251S0007X | Sports Physical Therapist | — | — | — |
| 2251X0800X | Orthopedic Physical Therapist | — | NULL | — |
| 2251X0800X | Orthopedic Physical Therapist | — | — | — |

## Other

- **Enumeration date:** 08/30/2021
- **Last updated:** 06/02/2022