Provider Demographics
NPI:1225785512
Name:REVIVE THERAPY LLC
Entity Type:Organization
Organization Name:REVIVE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPY SERVICES MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:NANCE
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:844-777-2267
Mailing Address - Street 1:2000 W MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-5446
Mailing Address - Country:US
Mailing Address - Phone:844-777-2267
Mailing Address - Fax:
Practice Address - Street 1:2000 W MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-5446
Practice Address - Country:US
Practice Address - Phone:844-777-2267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-07
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty