Organization
REVIVE REHAB SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MUHAMMAD JASIM (OWNER)
(484) 891-0608
Entity
Organization
Contact information
Practice address
623 W UNION BLVD STE 1B, BETHLEHEM, PA 18018-3708
(484) 891-0608
(484) 283-2232
Mailing address
1015 YORKSHIRE DR, BREINIGSVILLE, PA 18031-1544
(484) 891-0608
(484) 283-2232
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102786220
—
PA
Enumeration date
07/14/2012
Last updated
02/03/2021
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