Provider Demographics
NPI:1598426983
Name:REVITA, CHARO
Entity Type:Individual
Prefix:
First Name:CHARO
Middle Name:
Last Name:REVITA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CLEVELAND ST STE 525
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-4179
Mailing Address - Country:US
Mailing Address - Phone:800-211-0920
Mailing Address - Fax:
Practice Address - Street 1:601 CLEVELAND ST STE 525
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-4179
Practice Address - Country:US
Practice Address - Phone:800-211-0920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist