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General NPI Number Information
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NPI Number | 1184298424
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Entity Type | Organization
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Legal Business Name | REVIVAL PERFORMANCE PHYSICAL THERAPY
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 02/16/2023
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Provider Practice Location Address
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Address Line | 10300 HERITAGE ST STE 160
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City | SAN ANTONIO
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State | TX
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Zip | 78216-3924
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Country | US
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Telephone | 210-750-9004
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Fax | 210-866-0201
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Provider Business Mailing Address
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Address Line | 10300 HERITAGE ST STE 160
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City | SAN ANTONIO
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State | TX
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Zip | 78216-3924
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Country | US
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Telephone | 210-750-9004
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Fax | 210-866-0201
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Authorized Official
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Title or Position | MANAGER
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Name | LAUREN SCHRANK
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Credential | PT, DPT
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Telephone | 210-750-9004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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