Healthcare Provider Details

I. General information

NPI: 1922998368
Provider Name (Legal Business Name): REVIVE PHYSICAL THERAPY & REHABILITATION SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 SHERWOOD TER STE 132-133
LAKE BLUFF IL
60044-2255
US

IV. Provider business mailing address

7687 GAMAY CT
GURNEE IL
60031-5621
US

V. Phone/Fax

Practice location:
  • Phone: 224-212-0624
  • Fax:
Mailing address:
  • Phone: 317-640-5302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ABBEY E EDMONDS
Title or Position: OWNER / LEAD THERAPISTS
Credential: PT, DPT
Phone: 317-640-5302