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General NPI Number Information
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NPI Number | 1700756475
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Entity Type | Organization
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Legal Business Name | REVIVE PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 11/07/2025
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Last Update Date | 11/09/2025
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Provider Practice Location Address
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Address Line | 5675 STONE RD STE 200
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City | CENTREVILLE
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State | VA
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Zip | 20120-1667
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Country | US
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Telephone | 703-357-6161
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Fax |
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Provider Business Mailing Address
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Address Line | 23332 MINERVA DR
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City | BRAMBLETON
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State | VA
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Zip | 20148-6877
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPY
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Name | MRS. VINILA PEDDIBOYINA
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Credential | MPT
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Telephone | 703-357-6161
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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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