Provider Demographics
NPI:1407408198
Name:REVIVE OUTPATIENT SERVICES, LLC.
Entity Type:Organization
Organization Name:REVIVE OUTPATIENT SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KAUSHIK
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:269-589-9659
Mailing Address - Street 1:49578 E CENTRAL PARK
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-2412
Mailing Address - Country:US
Mailing Address - Phone:269-589-9659
Mailing Address - Fax:248-522-7916
Practice Address - Street 1:17200 E 10 MILE RD STE 137
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3355
Practice Address - Country:US
Practice Address - Phone:269-589-9659
Practice Address - Fax:248-522-7916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-12
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty