Organization
REVIVE PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRE WILLIAMS (OWNER)
(810) 555-5555
Entity
Organization
Contact information
Practice address
36180 DOMINION CIR, STERLING HEIGHTS, MI 48310-7456
(810) 555-5555
Mailing address
1665 BLOOMFIELD PLACE DR APT 422, BLOOMFIELD HILLS, MI 48302-3513
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
01/20/2020
Last updated
12/18/2020
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