MEDICARE: REVIVE PHYSICAL THERAPY

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1629743364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVIVE PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	160 NW GILMAN BLVD STE 304
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-2549
Country	:	US
Telephone Number	:	678-429-6435
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 NW GILMAN BLVD STE 304
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-2549
Country	:	US
Telephone Number	:	678-429-6435
Fax Number	:

Authorized Official
Title or Position	:	CLINIC OWNER
Name	:	MEENAKSHI SINGH
Credential	:	PT
Telephone Number	:	678-429-6435

Provider Enumeration Date	:	08/13/2021
Last Update Date	:	08/13/2021

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Directions to “REVIVE PHYSICAL THERAPY ” Practice Location

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