Organization
REVIVE PERFORMANCE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RYAN CLARK LAT, ATC (OWNER, ATHLETIC TRAINER)
(405) 778-4088
Entity
Organization
Contact information
Practice address
3333 W HEFNER RD, OKLAHOMA CITY, OK 73120-5060
(405) 237-5941
(405) 237-5941
Mailing address
5012 SW 129TH CT, OKLAHOMA CITY, OK 73173-8882
(405) 237-5941
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
02/02/2026
Last updated
02/02/2026
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