Healthcare Provider Details

I. General information

NPI: 1184387235
Provider Name (Legal Business Name): REVIVE INTEGRATIVE HEALTH LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 E IRON AVE STE C
SALINA KS
67401-2697
US

IV. Provider business mailing address

645 E IRON AVE STE C
SALINA KS
67401-2697
US

V. Phone/Fax

Practice location:
  • Phone: 785-577-5736
  • Fax: 785-200-3765
Mailing address:
  • Phone: 785-577-5736
  • Fax: 785-200-3765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHAYLA TROST
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 785-577-5736