Provider Demographics
NPI:1265085955
Name:REVIVE PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:REVIVE PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:303-709-1611
Mailing Address - Street 1:14389 COUNTY ROAD 5
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:CO
Mailing Address - Zip Code:80504-9803
Mailing Address - Country:US
Mailing Address - Phone:303-709-1611
Mailing Address - Fax:
Practice Address - Street 1:14389 COUNTY ROAD 5
Practice Address - Street 2:
Practice Address - City:MEAD
Practice Address - State:CO
Practice Address - Zip Code:80504-9803
Practice Address - Country:US
Practice Address - Phone:303-709-1611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty