Andrew Phillip Revak, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

13378-24 Issued in WI

Practice address

1705 16TH Ave
Cumberland, WI 54829-8601

Phone

(715) 822-7300

Fax

(715) 822-7301

NPI assigned

May 27, 2016

Last updated

Apr 21, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cumberland Memorial Hospital Inc

  • Critical Access Hospital
  • Cumberland, WI
  • NPI 1831243757
  Medicare reassignment

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

{
    "created_epoch": "1464307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776729600000",
    "number": "1659729929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 16TH AVE",
            "city": "CUMBERLAND",
            "state": "WI",
            "postal_code": "548298601",
            "telephone_number": "715-822-7300",
            "fax_number": "715-822-7301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 16TH AVE",
            "city": "CUMBERLAND",
            "state": "WI",
            "postal_code": "548298601",
            "telephone_number": "715-822-7300",
            "fax_number": "715-822-7301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REVAK",
        "first_name": "ANDREW",
        "middle_name": "PHILLIP",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-27",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "13378-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Optima Natural Health & Wellness, LLC
• Harriet Ailene Osumi, OTR
• Nicholas Pedersen
• John Pulvino
• Ashley Regimbal, APNP
• Jessica Richards, D.C.
• Jayne L Rieper, NP
• Stacy Rischette, LAC
• Ally Roberts, RD
• Susan Rouzer

• Physical Therapist in Cumberland, WI
• Providers in Cumberland, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2026; 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.