Healthcare Provider Details

I. General information

NPI: 1558099747
Provider Name (Legal Business Name): RHIVIVE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 MEADOWLANDS DR STE 10
WHITE BEAR LAKE MN
55127-2306
US

IV. Provider business mailing address

4399 SNAIL LAKE CT E
SHOREVIEW MN
55126-2124
US

V. Phone/Fax

Practice location:
  • Phone: 651-894-4585
  • Fax: 612-884-9489
Mailing address:
  • Phone: 651-894-4585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RHIANNON M LEGARDE
Title or Position: OWNER AND PHYSICAL THERAPIST
Credential: DPT
Phone: 651-894-4585