Organization
REVIVAL PHYSICAL THERAPY & REHABILITATION SERVICES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLATUNJI GBOTOSHO (PT)
(914) 948-7641
Entity
Organization
Contact information
Practice address
3706 THIRD AVE, BRONX, NY 10456-2145
(347) 591-4136
(347) 726-3036
Mailing address
102 GIBSON AVE, WHITE PLAINS, NY 10607-2030
(914) 358-5483
(914) 358-5484
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
017179
NY
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Enumeration date
12/10/2009
Last updated
08/20/2010
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