Provider Demographics
NPI:1194192294
Name:REVIVE BOOST REBUILD PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:REVIVE BOOST REBUILD PHYSICAL THERAPY LLC
Other - Org Name:RBR PT LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:CONTI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:919-917-7729
Mailing Address - Street 1:1300 CORPORATION PKWY
Mailing Address - Street 2:STE B
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1362
Mailing Address - Country:US
Mailing Address - Phone:919-917-7729
Mailing Address - Fax:919-400-4178
Practice Address - Street 1:1300 CORPORATION PKWY
Practice Address - Street 2:STE B
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1362
Practice Address - Country:US
Practice Address - Phone:919-917-7729
Practice Address - Fax:919-400-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13508225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty