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General NPI Number Information
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NPI Number | 1932059631
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Entity Type | Organization
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Legal Business Name | REVIVE PERFORMANCE, INC.
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Dates
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Enumeration Date | 02/02/2026
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Last Update Date | 02/02/2026
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Provider Practice Location Address
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Address Line | 3333 W HEFNER RD
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-5060
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Country | US
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Telephone | 405-237-5941
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Fax | 405-237-5941
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Provider Business Mailing Address
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Address Line | 5012 SW 129TH CT
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City | OKLAHOMA CITY
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State | OK
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Zip | 73173-8882
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Country | US
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Telephone | 405-237-5941
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Fax |
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Authorized Official
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Title or Position | OWNER, ATHLETIC TRAINER
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Name | MR. RYAN CLARK
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Credential | LAT, ATC
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Telephone | 405-778-4088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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