Provider Demographics
NPI:1528527942
Name:REVIVE THERAPY LLC
Entity type:Organization
Organization Name:REVIVE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTORO III
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:203-980-8166
Mailing Address - Street 1:527 QUINNIPIAC AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3344
Mailing Address - Country:US
Mailing Address - Phone:203-980-8166
Mailing Address - Fax:
Practice Address - Street 1:462-470 WASHINGTON AVE
Practice Address - Street 2:UNITS 1-3
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-1311
Practice Address - Country:US
Practice Address - Phone:203-980-8166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy