Provider Demographics
NPI:1598339269
Name:REVIVE MOVEMENT LLC
Entity Type:Organization
Organization Name:REVIVE MOVEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:206-719-7186
Mailing Address - Street 1:3504 SW WEBSTER ST APT 213
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-3252
Mailing Address - Country:US
Mailing Address - Phone:206-719-7186
Mailing Address - Fax:
Practice Address - Street 1:3504 SW WEBSTER ST APT 213
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-3252
Practice Address - Country:US
Practice Address - Phone:206-719-7186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty