Provider Demographics
NPI:1124591607
Name:REVITALIZE MOVEMENT PHYSICAL THERAPY STUDIO LLC
Entity Type:Organization
Organization Name:REVITALIZE MOVEMENT PHYSICAL THERAPY STUDIO LLC
Other - Org Name:FYZICAL THERAPY AND BALANCE CENTER SNOQUALMIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:APPLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:206-930-7476
Mailing Address - Street 1:35314 SE CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-9216
Mailing Address - Country:US
Mailing Address - Phone:206-930-7476
Mailing Address - Fax:425-642-3057
Practice Address - Street 1:35314 SE CENTER ST
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065-9216
Practice Address - Country:US
Practice Address - Phone:206-930-7476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty