Organization
REVIVE PHYSICAL THERAPY, LLC
Active
Organization
REVIVE PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TANYA BROUSSARD (CREDENTIALING SPECIALIST)
(337) 704-5611
Entity
Organization
Contact information
Practice address
12550 AIRLINE HWY STE 102, GONZALES, LA 70737-2269
(985) 703-2412
Mailing address
3261 EFFIE RD, HESTER, LA 70743
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
01/29/2018
Last updated
01/29/2018
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