Provider Demographics
NPI:1710736624
Name:CORE REVIVAL PELVIC HEALTH & PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:CORE REVIVAL PELVIC HEALTH & PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-659-5852
Mailing Address - Street 1:923 LAKE PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-4641
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:923 LAKE PARK BLVD
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-4641
Practice Address - Country:US
Practice Address - Phone:630-659-5852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy