Organization
REVISION HEALTH SERVICES, PLLC
Active
Organization
REVISION HEALTH SERVICES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL DERRY PT (CEO)
(309) 267-9873
Entity
Organization
Contact information
Practice address
131 VALLEY GROVE DR, PONTE VEDRA, FL 32081-6165
(309) 267-9873
Mailing address
908 W 1ST ST, SPRING VALLEY, IL 61362-1135
(309) 267-9873
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
05/21/2020
Last updated
05/29/2020
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