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Organization
REVIVE PHYSICAL THERAPY AND WELLNESS CENTER
Active
Organization
REVIVE PHYSICAL THERAPY AND WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE SHIAO DPT (PT/OWNER/DIRECTOR)
(732) 662-7927
Entity
Organization
Contact information
Practice address
1941 OAK TREE RD STE 302, EDISON, NJ 08820-2068
(732) 662-7927
(732) 662-7928
Mailing address
1941 OAK TREE RD STE 302, EDISON, NJ 08820-2068
(732) 662-7927
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40QA00943300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40QA00943300
STATE LICENSE NUMBER
NJ
Enumeration date
12/08/2008
Last updated
12/08/2008
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