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General NPI Number Information
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NPI Number | 1164222469
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Entity Type | Organization
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Legal Business Name | REVIVE PHYSICAL THERAPY & TRAINING LLC
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 3912 SLATE DR
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City | CHAMPAIGN
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State | IL
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Zip | 61822-4200
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Country | US
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Telephone | 913-522-9971
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Fax |
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Provider Business Mailing Address
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Address Line | 3912 SLATE DR
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City | CHAMPAIGN
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State | IL
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Zip | 61822-4200
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Country | US
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Telephone | 913-522-9971
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DANIEL CUMMINS
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Credential | PT, DPT
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Telephone | 913-522-9971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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