MEDICARE: REVIVE AGAIN THERAPEUTIC SERVICES

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1659221315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVIVE AGAIN THERAPEUTIC SERVICES

Provider Business Mailing Address
First Line	:	265 HOLLOW RIDGE AVE
Second Line	:
City	:	GONZALES
State	:	LA
Zip	:	70737-7545
Country	:	US
Telephone Number	:	985-232-8449
Fax Number	:	985-232-8449

Provider Business Practice Location Address
First Line	:	231 W CORNERVIEW ST
Second Line	:
City	:	GONZALES
State	:	LA
Zip	:	70737-2841
Country	:	US
Telephone Number	:	985-232-8449
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MIYOKIA CARTER
Credential	:	CARTER
Telephone Number	:	985-232-8449

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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