Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Revelle Goldsmith

Individual provider Rehabilitation Practitioner · NPI 1164071353

Revelle Goldsmith is a Rehabilitation Practitioner in Waterloo, Illinois. Practices as a sole proprietor. Registered with an NPI since 2019.

In the registry since
2019
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Practice location Address checks out

988 N Illinois Route 3
Waterloo, IL 62298-1059
Phone: (618) 939-4444
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Specialties & licences

Rehabilitation Practitioner (primary) Taxonomy 225400000X

Record details

NPI number1164071353
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedSeptember 10, 2019
Last updated in NPPESSeptember 10, 2019
Mailing address988 N Illinois Route 3, Waterloo, IL 62298-1059

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