Organization
REVIVE ATHLETICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW HARRELL (OWNER)
(678) 308-5520
Entity
Organization
Contact information
Practice address
201 ST. CHARLES AVE., STE. 2500, NEW ORLEANS, LA 70170-2500
(504) 754-6904
(800) 675-4619
Mailing address
201 ST. CHARLES AVE., STE. 2500, NEW ORLEANS, LA 70170-2500
(504) 754-6904
(800) 675-4619
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
07/01/2015
Last updated
07/01/2015
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