Provider Demographics
| NPI: | 1841034535 |
|---|---|
| Name: | REVIVE THERAPY AND PERFORMANCE, LLC |
| Entity type: | Organization |
| Organization Name: | REVIVE THERAPY AND PERFORMANCE, LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTOR OF OPERATIONS |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | JESSANNA |
| Authorized Official - Middle Name: | GRAYCE |
| Authorized Official - Last Name: | SCHUMANN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 620-217-0583 |
| Mailing Address - Street 1: | 324 E 2ND ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MOUNDRIDGE |
| Mailing Address - State: | KS |
| Mailing Address - Zip Code: | 67107-7164 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 620-345-7400 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 324 E 2ND ST |
| Practice Address - Street 2: | |
| Practice Address - City: | MOUNDRIDGE |
| Practice Address - State: | KS |
| Practice Address - Zip Code: | 67107-7164 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 620-345-7400 |
| Practice Address - Fax: | 620-345-7410 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2024-06-19 |
| Last Update Date: | 2024-06-19 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225XH1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | Group - Multi-Specialty |
| No | 225XP0019X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Physical Rehabilitation | Group - Multi-Specialty |
| No | 225XR0403X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Driving and Community Mobility | Group - Multi-Specialty |
| No | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics | Group - Multi-Specialty |
| No | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology | Group - Multi-Specialty |
| No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | Group - Multi-Specialty |
| No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | Group - Multi-Specialty |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty |
