NPIMap

Organization Active NPI

Revitalize Athletics, PLLC

  • Physical Therapist
  • Lakewood, CO
National Provider Identifier
1790411569
Registry record updated Jul 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
REVITALIZE ATHLETICS, PLLC
Practice address
9643 W 14TH Ave
Lakewood, CO 80215-4755
Phone
(626) 512-5559
NPI assigned
Jul 25, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2022

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

Authorized official

Name
Tara Loveland, DPTNPI 1053902403
Title
Physical Therapist/Owner
Phone
(626) 512-5559

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

9643 W 14TH Ave
Lakewood, CO 80215-4755

Mailing address

9643 W 14TH Ave
Lakewood, CO 80215-4755
Phone (626) 512-5559

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": "1658707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658707200000",
    "number": "1790411569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9643 W 14TH AVE",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802154755",
            "telephone_number": "626-512-5559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9643 W 14TH AVE",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802154755",
            "telephone_number": "626-512-5559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALIZE ATHLETICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-25",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A",
        "authorized_official_last_name": "LOVELAND",
        "authorized_official_first_name": "TARA",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST/OWNER",
        "authorized_official_telephone_number": "626-512-5559",
        "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": []
}

Other providers in Lakewood, CO

Sources for this page

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