Revitalyz Wellness Center, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA01420300 Issued in NJ

Legal business name

REVITALYZ WELLNESS CENTER, LLC

Practice address

1222 John F. Kennedy Blvd
Bayonne, NJ 07002

Phone

(201) 932-0197

NPI assigned

Nov 18, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Chris Cabrera

Title

Executive Director

Phone

(201) 932-0197

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1447804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467849600000",
    "number": "1013381763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1222 JOHN F. KENNEDY BLVD",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "07002",
            "telephone_number": "201-932-0197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1222 JOHN F. KENNEDY BLVD",
            "city": "BAYONNE",
            "state": "NJ",
            "postal_code": "07002",
            "telephone_number": "201-932-0197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVITALYZ WELLNESS CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-18",
        "last_updated": "2016-07-07",
        "status": "A",
        "authorized_official_last_name": "CABRERA",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "201-932-0197"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA01420300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Bayonne, NJ
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• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.