Revive Sport & Spine

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

91235421202 Issued in UT

Legal business name

REVIVE SPORT & SPINE

Practice address

1996 E 6400 S Ste 260
Murray, UT 84121-2173

Phone

(801) 944-1855

Fax

(385) 351-5950

NPI assigned

Aug 20, 2015

Last updated

Oct 9, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Andrew J Reheisse, D.C.NPI 1003217449

Title

Owner

Phone

(801) 944-1855

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Andrew J Reheisse, D.C.

  • Sports Physician Chiropractor
  • Murray, UT
  • NPI 1003217449
  Medicare reassignment NPD Authorized official
• Jordan Mousley, D.C.

  • Chiropractor
  • Midvale, UT
  • NPI 1013465632
  NPD (past)

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

{
    "created_epoch": "1440028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759968000000",
    "number": "1649646969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1996 E 6400 S STE 260",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841212173",
            "telephone_number": "801-944-1855",
            "fax_number": "385-351-5950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1996 E 6400 S STE 260",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841212173",
            "telephone_number": "801-944-1855",
            "fax_number": "385-351-5950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE SPORT & SPINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-20",
        "last_updated": "2025-10-09",
        "certification_date": "2025-10-09",
        "status": "A",
        "authorized_official_last_name": "REHEISSE",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-944-1855",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "UT",
            "license": "91235421202",
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "UT",
            "license": "91235421202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacy Ann Renner, PT
• Daniel J Reschke, MD
• Melissa Retallick
• Return to Movement Physical Therapy PLLC
• James R Revenaugh, M.D.
• Cristina Reyes
• Yolanda Reyes
• Casey Jay Reynolds Jr., DNP, NP-C
• Elizabeth Grace Reynolds
• Kara Renee Reynolds, O.D.

• Sports Physician Chiropractor in Murray, UT
• Providers in Murray, UT by specialty
• Sports Physician Chiropractor in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.