REVIVE PHYSICAL THERAPY, LLC (NPI# 1982102620) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982102620 |
| Entity Type | Organization |
| Organization Name | REVIVE PHYSICAL THERAPY, LLC |
| Practice Address |
12550 Airline Hwy Ste 102 Gonzales LA 70737-2269 |
| Mailing Address |
3261 Effie Rd Hester LA 70743 |
| Practice Telephone | 9857032412 |
| Enumeration Date | 2018-01-29 |
| Last Update Date | 2018-01-29 |
| Authorized Official Name | TANYA BROUSSARD (CREDENTIALING SPECIALIST) |
| Authorized Official Telephone | 3377045611 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962044735 | Revive Physical Therapy, LLC | Physical Therapist | 980 Ute Ln, Gunnison, CO 81230-8704 | 2019-10-14 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Colorado Business Entities | Revive Physical Therapy, LLC | 980 Ute Lane, Gunnison, CO 81230 |
| Oregon Corporations, Companies and Business Names | REVIVE PHYSICAL THERAPY, LLC | 18091 Sw Lower Boones Ferry, Portland, OR 97224 |
| Street Address |
12550 AIRLINE HWY STE 102 |
| City | GONZALES |
| State | LA |
| Zip Code | 70737-2269 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407461593 | Scott G Petrie Md Apmc | Non-Pharmacy Dispensing Site | 1014 West St Clare Boulevard, Ste 1020, Gonzales, LA 70737 | 2020-09-15 |
| 1407461981 | Bryant Louis Bourgeois | Dentist | 13317 N Burnside, Gonzales, LA 70737 | 2020-09-11 |
| 1821612631 | Kene Anje Hamilton | Behavioral Analyst | 1028 East Worthy Street, Gonzales, LA 70737 | 2020-06-08 |
| 1801428636 | Mercedes Francis | Behavior Technician | 1023 E W Worthy Rd, Gonzales, LA 70737 | 2020-02-10 |
| 1407347586 | Functional Dme | Prosthetic/Orthotic Supplier | 219 W. Eastbank St., Ste B, Gonzales, LA 70737 | 2018-05-23 |
| 1235631789 | Transporting On Purpose | Non-emergency Medical Transport (VAN) | 42148 Conifer Drive, Gonzales, LA 70737 | 2018-03-01 |
| 1215453121 | Michelle Fuller Harris | Social Worker | 39094 N Angelle Ct, Gonzales, LA 70737 | 2017-08-22 |
| 1215452529 | Lani Litchfield | Specialist/Technologist | 13341 W. Mill Grove Dr, Gonzales, LA 70737 | 2017-08-08 |
| 1326569369 | Tyler Joshua Turner | Counselor | 1923 South Edwards, Gonzales, LA 70737 | 2017-06-29 |
| 1518408046 | Margaret Madere | Social Worker | 2827 S Ruby Street, Gonzales, LA 70737 | 2017-03-16 |
| Find all providers in zip 70737 | ||||
| Taxonomy Code | 261QP2000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Physical Therapy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831663400 | Caitlin Walker | Clinic/Center | 1300 Captain Albert Martin Trail, Gonzales, TX 78629 | 2019-01-17 |
| 1497033831 | Baton Rouge Orthopaedic Clinic, LLC | Clinic/Center | 625 S Burnside Ave, Unit 9, Gonzales, LA 70737-3400 | 2011-08-03 |
| 1154631836 | Joy Rehab Corp | Clinic/Center | 108 E Sanders St, Gonzales, LA 70737-3144 | 2010-10-15 |
| 1881717650 | Advanced Rehabilitation of Gonzales | Clinic/Center | 2211 S Burnside Ave, Gonzales, LA 70737 | 2007-04-09 |
| 1396831699 | Alliance Therapy Services, Inc | Clinic/Center | 12320 Highway 44 Bldg 3f, Gonzales, LA 70737-2202 | 2006-10-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447851878 | Geaux Fight Rehabilitation Services, LLC | Clinic/Center | 424 W 15th Ave, Covington, LA 70433-3310 | 2020-11-03 |
| 1558961185 | Ashley Marie Cagle | Clinic/Center | 837 Birdnest Rd, Lake Charles, LA 70611-5816 | 2020-11-01 |
| 1437766961 | Louisiana Concierge Physical Therapy, LLC | Clinic/Center | 10710 Misty Vale Ave, Baton Rouge, LA 70810-3030 | 2020-09-29 |
| 1043836141 | Rehab Plus, LLC | Clinic/Center | 1242 S Morrison Blvd Ste O, Hammond, LA 70403-5702 | 2020-06-24 |
| 1972142024 | Resilience Concierge Physical Therapy | Clinic/Center | 609 Woodmere Dr, Shreveport, LA 71115-3815 | 2020-01-06 |
| 1437796943 | Angels of Therapy LLC | Clinic/Center | 1503 Gause Blvd Ste 6, Slidell, LA 70458-2246 | 2019-12-03 |
| 1598308884 | Bennett Physical Therapy, LLC | Clinic/Center | 64167 Highway 41 Ste C, Pearl River, LA 70452-3638 | 2019-10-20 |
| 1235791930 | Lakeview Physical Therapy and Spine LLC | Clinic/Center | 435 28th St, New Orleans, LA 70124-1327 | 2019-07-02 |
| 1700446846 | Unlock Physical Therapy LLC | Clinic/Center | 3810 Ambassador Caffery Pkwy Ste 500, Lafayette, LA 70503-5266 | 2019-06-20 |
| 1104385095 | Injurymd, LLC | Clinic/Center | 1715 Marycrest Ave Ste 200, Shreveport, LA 71101-5074 | 2019-03-19 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.