Provider Demographics
NPI:1780579086
Name:REVETTE PHYSICAL THERAPY AND SPORTS PERFORMANCE LLC
Entity type:Organization
Organization Name:REVETTE PHYSICAL THERAPY AND SPORTS PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAITLYN
Authorized Official - Middle Name:GRIFFITH
Authorized Official - Last Name:REVETTE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:256-523-2200
Mailing Address - Street 1:400 COUNTY ROAD 574
Mailing Address - Street 2:
Mailing Address - City:CENTRE
Mailing Address - State:AL
Mailing Address - Zip Code:35960-6658
Mailing Address - Country:US
Mailing Address - Phone:256-523-2200
Mailing Address - Fax:
Practice Address - Street 1:1504 CHESNUT BYP
Practice Address - Street 2:
Practice Address - City:CENTRE
Practice Address - State:AL
Practice Address - Zip Code:35960-2816
Practice Address - Country:US
Practice Address - Phone:256-523-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy