Healthcare Provider Details

I. General information

NPI: 1801515820
Provider Name (Legal Business Name): REVITALIZE REHAB PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 HILLCREST CIR
WESTFIELD MA
01085-1871
US

IV. Provider business mailing address

43 HILLCREST CIR
WESTFIELD MA
01085-1871
US

V. Phone/Fax

Practice location:
  • Phone: 413-563-8566
  • Fax:
Mailing address:
  • Phone: 413-563-8566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: HASAAN KHAWAJA
Title or Position: OWNER
Credential: DPT
Phone: 413-563-8566