Organization
REVITALIZE 3D
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN PATRICK COLLINS DPT (OWNER/CEO)
(785) 477-2647
Entity
Organization
Contact information
Practice address
184 W 400 N, PROVO, UT 84601-2855
(785) 477-2647
Mailing address
1427 S 680 W, PROVO, UT 84601-5544
(785) 477-2647
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
2251E1200X
Ergonomics Physical Therapist
—
—
2251G0304X
Geriatric Physical Therapist
—
—
2251H1300X
Human Factors Physical Therapist
—
—
2251S0007X
Sports Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
Other
Enumeration date
08/30/2021
Last updated
06/02/2022
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