MEDICARE: REVIVE REHAB, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1952168429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVIVE REHAB, LLC

Provider Business Mailing Address
First Line	:	2800 FORUM BLVD STE 2
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-5468
Country	:	US
Telephone Number	:	660-247-1043
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 FORUM BLVD STE 2
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-5468
Country	:	US
Telephone Number	:	573-257-8580
Fax Number	:	855-710-4225

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	DR. SARAH MILLER
Credential	:	DPT
Telephone Number	:	660-247-1043

Provider Enumeration Date	:	03/01/2024
Last Update Date	:	12/09/2025

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