Provider Demographics
NPI:1558099747
Name:RHIVIVE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:RHIVIVE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RHIANNON
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEGARDE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:651-894-4585
Mailing Address - Street 1:4399 SNAIL LAKE CT E
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-2124
Mailing Address - Country:US
Mailing Address - Phone:651-894-4585
Mailing Address - Fax:
Practice Address - Street 1:1011 MEADOWLANDS DR STE 10
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55127-2306
Practice Address - Country:US
Practice Address - Phone:651-894-4585
Practice Address - Fax:612-884-9489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy