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General NPI Number Information
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NPI Number | 1699506733
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Entity Type | Organization
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Legal Business Name | REVIVE HEALTH PT LLC
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Dates
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Enumeration Date | 08/10/2024
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Last Update Date | 08/10/2024
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Provider Practice Location Address
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Address Line | 9892 BUSTLETON AVE STE 206
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City | PHILADELPHIA
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State | PA
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Zip | 19115-2139
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Country | US
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Telephone | 215-866-6333
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Fax |
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Provider Business Mailing Address
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Address Line | 3516 SUNSET WAY
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City | HUNTINGDON VALLEY
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State | PA
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Zip | 19006-7749
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Country | US
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Telephone | 215-866-6333
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | GRINBERG GRINBERG
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Credential | PT
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Telephone | 215-866-6333
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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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