Revive Physical Therapy, LLC
Clinic/Center, Physical Therapy in Gonzales, LA. Organization (NPI-2).
NPI number1982102620
StatusActive
Last updated in NPPESJan 29, 2018
Details
- NPI
- 1982102620
- Entity type
- Organization (NPI-2)
- Legal business name
- Revive Physical Therapy, LLC
- Organization subpart
- No
- Enumeration date
- Jan 29, 2018
- Last updated
- Jan 29, 2018
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP2000X | Clinic/Center, Physical Therapy | – | – | Yes |
Practice location
12550 Airline Hwy Ste 102Gonzales, LA 70737-2269
Phone 985-703-2412
Mailing address
3261 Effie RdHester, LA 70743
Authorized official
Tanya Broussard
Credentialing Specialist
3377045611
Is something wrong?
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Other Physical Therapy Clinic/Center providers in Gonzales, LA
- Advanced Rehabilitation Of GonzalesNPI 1881717650
- Alliance Therapy Services, INCNPI 1396831699
- Baton Rouge Orthopaedic Clinic, LLCNPI 1497033831
- Joy Rehab CorpNPI 1154631836
All 5 Physical Therapy Clinic/Center providers in Gonzales · All 969 providers in Gonzales
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