Provider Demographics
NPI:1407729494
Name:REVIVE PHYSICAL THERAPY & WELLNESS LLC
Entity type:Organization
Organization Name:REVIVE PHYSICAL THERAPY & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEEZA
Authorized Official - Middle Name:
Authorized Official - Last Name:METELEVA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:781-879-0858
Mailing Address - Street 1:210 N MAIN ST UNIT 9
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1276
Mailing Address - Country:US
Mailing Address - Phone:781-390-9819
Mailing Address - Fax:781-512-6403
Practice Address - Street 1:210 N MAIN ST UNIT 9
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-1276
Practice Address - Country:US
Practice Address - Phone:781-390-9819
Practice Address - Fax:781-512-6403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty