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General NPI Number Information
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NPI Number | 1598339269
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Entity Type | Organization
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Legal Business Name | REVIVE MOVEMENT LLC
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Dates
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Enumeration Date | 05/18/2021
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 3504 SW WEBSTER ST APT 213
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City | SEATTLE
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State | WA
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Zip | 98126-3252
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Country | US
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Telephone | 206-719-7186
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Fax |
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Provider Business Mailing Address
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Address Line | 3504 SW WEBSTER ST APT 213
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City | SEATTLE
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State | WA
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Zip | 98126-3252
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Country | US
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Telephone | 206-719-7186
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | DENISE GRIFFITH
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Credential | DPT
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Telephone | 206-719-7186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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