Revive Neurorecovery Center CLT LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

REVIVE NEURORECOVERY CENTER CLT LLC

Practice address

3463 Highway 21 Ste 112
Fort Mill, SC 29715-7210

Phone

(704) 900-3674

NPI assigned

Aug 11, 2022

Organization subpart

No

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

Authorized official

Name

Ashley Clark, DPTNPI 1669787107

Title

Owner

Phone

(704) 900-3674

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Ashley E Clark, PT

  • Physical Therapist
  • Fort Mill, SC
  • NPI 1669787107
  NPD Authorized official

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

{
    "created_epoch": "1660176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708819200000",
    "number": "1679201123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3463 HIGHWAY 21 STE 112",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297157210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3463 HIGHWAY 21 STE 112",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297157210",
            "telephone_number": "704-900-3674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE NEURORECOVERY CENTER CLT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-11",
        "last_updated": "2024-02-25",
        "certification_date": "2024-02-25",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-900-3674",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bryan Renken, M.D.
• Imani Rentz
• Restore Healthcare
• Revival Counseling of the Carolinas
• Revive Chiropractic PC
• Ashley Reyes, RBT
• Natalie Reynolds, RBT
• Nathan Reynolds, LMT
• Norka Reynolds
• Kendrah Rhoden, RBT

• Physical Therapist in Fort Mill, SC
• Providers in Fort Mill, SC by specialty
• Physical Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2024; 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.