=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801515820
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REVITALIZE REHAB PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2022
-----------------------------------------------------
Last Update Date | 04/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 43 HILLCREST CIR
-----------------------------------------------------
City | WESTFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01085-1871
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-563-8566
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 43 HILLCREST CIR
-----------------------------------------------------
City | WESTFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01085-1871
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-563-8566
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | HASAAN KHAWAJA
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 413-563-8566
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------