NPIMap

Organization Active NPI

Revolution Health and Performance, PLLC

  • Physical Therapist
  • Springfield, IL
National Provider Identifier
1215689641
Registry record updated Jan 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
REVOLUTION HEALTH AND PERFORMANCE, PLLC
Practice address
192 Wisteria Dr
Springfield, IL 62711-9258
Phone
(913) 967-9215
NPI assigned
Jan 26, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Daniel Staton Rebeck, PT, DPTNPI 1467061408
Title
Physical Therapist
Phone
(913) 967-9215

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

192 Wisteria Dr
Springfield, IL 62711-9258

Mailing address

192 Wisteria Dr
Springfield, IL 62711-9258

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643155200000",
    "number": "1215689641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "192 WISTERIA DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627119258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "192 WISTERIA DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627119258",
            "telephone_number": "913-967-9215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTION HEALTH AND PERFORMANCE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-26",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A",
        "authorized_official_last_name": "REBECK",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "STATON",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "913-967-9215",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.