Provider Demographics
NPI:1962649467
Name:REVA REID THERAPY SERVICES
Entity Type:Organization
Organization Name:REVA REID THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:REVA
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, MOT
Authorized Official - Phone:607-669-4891
Mailing Address - Street 1:3390 HANCE RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-5756
Mailing Address - Country:US
Mailing Address - Phone:607-669-4891
Mailing Address - Fax:
Practice Address - Street 1:3390 HANCE RD
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-5756
Practice Address - Country:US
Practice Address - Phone:607-669-4891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005407-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherEARLY INTERVENTION PROGRAM PROVIDER