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General NPI Number Information
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NPI Number | 1720707565
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Entity Type | Organization
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Legal Business Name | REVIVAL WELLNESS, LLC
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Dates
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Enumeration Date | 08/24/2022
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Last Update Date | 08/24/2022
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Provider Practice Location Address
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Address Line | 1949 N HIGHWAY 99
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City | EMPORIA
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State | KS
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Zip | 66801-8163
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Country | US
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Telephone | 620-412-3381
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Fax |
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Provider Business Mailing Address
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Address Line | 1949 N HIGHWAY 99
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City | EMPORIA
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State | KS
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Zip | 66801-8163
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Country | US
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Telephone | 620-412-3381
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MRS. TAYLOR DANIELLE KIRK
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Credential | DPT
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Telephone | 620-412-3381
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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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