Organization
REVIVE THERAPY AND PERFORMANCE, LLC
Active
Other names
Revive Therapy and Performance
Organization subpart
No
Provider details
NPI number
Authorized official
JESSANNA GRAYCE SCHUMANN (DIRECTOR OF OPERATIONS)
(620) 217-0583
Entity
Organization
Contact information
Practice address
324 E 2ND ST, MOUNDRIDGE, KS 67107-7164
(620) 345-7400
(620) 345-7410
Mailing address
324 E 2ND ST, MOUNDRIDGE, KS 67107-7164
(620) 345-7400
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
2251G0304X
Geriatric Physical Therapist
—
—
2251N0400X
Neurology Physical Therapist
—
—
2251S0007X
Sports Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
225XH1200X
Hand Occupational Therapist
—
—
225XP0019X
Physical Rehabilitation Occupational Therapist
—
—
225XR0403X
Driving and Community Mobility Occupational Therapist
—
—
Other
Enumeration date
06/19/2024
Last updated
06/19/2024
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