Organization
REVIVE REHAB CENTER II LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGIE BAZZI (OWNER)
(313) 469-8890
Entity
Organization
Contact information
Practice address
20311 MACK AVE STE 1, GROSSE POINTE WOODS, MI 48236-1784
(313) 469-8890
(313) 469-6971
Mailing address
20311 MACK AVE STE 1, GROSSE POINTE WOODS, MI 48236-1784
(313) 469-8890
(313) 469-6971
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MI
Enumeration date
06/14/2017
Last updated
07/21/2022
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