Healthcare Provider Details

I. General information

NPI: 1124939632
Provider Name (Legal Business Name): RESURGENS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6495 SHILOH RD STE 100
ALPHARETTA GA
30005-1635
US

IV. Provider business mailing address

PO BOX 21068
BELFAST ME
04915-4107
US

V. Phone/Fax

Practice location:
  • Phone: 770-888-3011
  • Fax: 770-888-3227
Mailing address:
  • Phone: 404-847-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BOBBI REVETTI
Title or Position: ANCILLARY OPERATIONS EA
Credential:
Phone: 404-575-4901