Provider Demographics
NPI:1740849132
Name:REVIVE MEDICAL & REHAB
Entity type:Organization
Organization Name:REVIVE MEDICAL & REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BOZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-515-1731
Mailing Address - Street 1:7125 MARINER BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-1048
Mailing Address - Country:US
Mailing Address - Phone:352-515-1731
Mailing Address - Fax:
Practice Address - Street 1:7125 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-1048
Practice Address - Country:US
Practice Address - Phone:352-515-1731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty