| Organization Name: | REVIVE PHYSICAL THERAPY AND WELLNESS CENTER |
| NPI Number: | 1609011493 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DIANE SHIAO (PT/OWNER/DIRECTOR) |
| Mailing Address: | 1941 Oak Tree Rd Ste 302 Edison |
| State: | NJ US |
| Postal Code: | 088202068 |
| Phone Number: | 7326627927 |
| Fax Number: | 7326627928 |
| NPI Enumeration Date: | 12/08/2008 |
| NPI Last Update Date: | 12/08/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 40QA00943300 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |