Healthcare Provider Details

I. General information

NPI: 1306784012
Provider Name (Legal Business Name): REVIVE LYMPHATICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E MAIN ST STE 1
SOMERSET PA
15501-2198
US

IV. Provider business mailing address

510 E MAIN ST STE 1
SOMERSET PA
15501-2198
US

V. Phone/Fax

Practice location:
  • Phone: 714-819-0158
  • Fax:
Mailing address:
  • Phone: 714-819-0158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELISE FRANCISCUS
Title or Position: OWNER, OCCUPATIONAL THERAPIST
Credential: MOT-OTR/L, CLT
Phone: 714-819-0158