Organization
REVIVE THERAPY AND PERFORMANCE, LLC
Active
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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