=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669321576
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REVIVE HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2026
-----------------------------------------------------
Last Update Date | 01/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2787 CRAWFORDVILLE HWY
-----------------------------------------------------
City | CRAWFORDVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32327-2172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-361-2404
-----------------------------------------------------
Fax | 850-600-1773
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2787 CRAWFORDVILLE HWY
-----------------------------------------------------
City | CRAWFORDVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32327-2172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-361-2404
-----------------------------------------------------
Fax | 850-600-1773
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FINANCIAL COORDINATOR
-----------------------------------------------------
Name | ANDREA J CARLTON
-----------------------------------------------------
Credential | CCPA
-----------------------------------------------------
Telephone | 850-459-7280
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------