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General NPI Number Information
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NPI Number | 1528527942
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Entity Type | Organization
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Legal Business Name | REVIVE THERAPY LLC
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Dates
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Enumeration Date | 03/15/2019
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 336 STATE ST STE 2-3
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City | NORTH HAVEN
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State | CT
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Zip | 06473-3170
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Country | US
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Telephone | 203-745-4973
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Fax |
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Provider Business Mailing Address
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Address Line | 527 QUINNIPIAC AVE
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City | NORTH HAVEN
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State | CT
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Zip | 06473-3344
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Country | US
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Telephone | 203-980-8166
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Fax |
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Authorized Official
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Title or Position | DPT/OWNER
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Name | ERNEST SANTORO III
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Credential | DPT
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Telephone | 203-980-8166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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