Provider Demographics
NPI:1437810546
Name:REVIVE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:REVIVE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BLAIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS/CCC-SLP
Authorized Official - Phone:561-247-7337
Mailing Address - Street 1:2151 45TH STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2028
Mailing Address - Country:US
Mailing Address - Phone:561-247-7337
Mailing Address - Fax:561-727-8908
Practice Address - Street 1:2151 45TH STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2028
Practice Address - Country:US
Practice Address - Phone:561-247-7337
Practice Address - Fax:561-727-8908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-02
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty