MEDICARE: REVIVE THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1528527942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVIVE THERAPY LLC

Provider Business Mailing Address
First Line	:	527 QUINNIPIAC AVE
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-3344
Country	:	US
Telephone Number	:	203-980-8166
Fax Number	:

Provider Business Practice Location Address
First Line	:	336 STATE ST STE 2-3
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-3170
Country	:	US
Telephone Number	:	203-745-4973
Fax Number	:

Authorized Official
Title or Position	:	DPT/OWNER
Name	:	ERNEST SANTORO III
Credential	:	DPT
Telephone Number	:	203-980-8166

Provider Enumeration Date	:	03/15/2019
Last Update Date	:	12/23/2025

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