Healthcare Provider Details

I. General information

NPI: 1871459461
Provider Name (Legal Business Name): REVISION WELLNESS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 W UPHAM ST
MARSHFIELD WI
54449-1460
US

IV. Provider business mailing address

203 W UPHAM ST
MARSHFIELD WI
54449-1460
US

V. Phone/Fax

Practice location:
  • Phone: 715-204-9697
  • Fax: 715-620-1355
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY FALK
Title or Position: MD
Credential:
Phone: 715-204-9697