Revival Physical Therapy & Rehabilitation Services, PC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

017179 Issued in NY

Legal business name

REVIVAL PHYSICAL THERAPY & REHABILITATION SERVICES, PC

Practice address

3706 Third Ave
Bronx, NY 10456-2145

Phone

(347) 591-4136

Fax

(347) 726-3036

NPI assigned

Dec 10, 2009

Organization subpart

No

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

Authorized official

Name

Olatunji GbotoshoNPI 1669615373

Title

PT

Phone

(914) 948-7641

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Olatunji Gbotosho

  • Physical Therapist
  • White Plains, NY
  • NPI 1669615373
  Medicare reassignment NPD Authorized official
• Kanchan Rana

  • Physical Therapist
  • Naperville, IL
  • NPI 1699212423
  NPD
• Ayman Abdalla Mahmoud Mohamed

  • Physical Therapist
  • New York, NY
  • NPI 1891460655
  NPD (past)
• Omar Mohamed

  • Physical Therapist
  • Brooklyn, NY
  • NPI 1275157281
  NPD (past)
• Wonhyo Kim, PHYSICAL THERAPIST

  • Physical Therapist
  • Riverwoods, IL
  • NPI 1922668326
  NPD (past)

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

{
    "created_epoch": "1260403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282262400000",
    "number": "1063741676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 GIBSON AVE",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106072030",
            "telephone_number": "914-358-5483",
            "fax_number": "914-358-5484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3706 THIRD AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104562145",
            "telephone_number": "347-591-4136",
            "fax_number": "347-726-3036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVAL PHYSICAL THERAPY & REHABILITATION SERVICES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-10",
        "last_updated": "2010-08-20",
        "status": "A",
        "authorized_official_last_name": "GBOTOSHO",
        "authorized_official_first_name": "OLATUNJI",
        "authorized_official_title_or_position": "PT",
        "authorized_official_telephone_number": "914-948-7641"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NY",
            "license": "017179",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Avi Samson Retter, MD
• Jaclyn Rose Rettig, ATC
• Samantha Reuter, PA
• Josef Reutershan, BSW
• Sofia Marie Reverendo, LMSW
• Revive Pharmacy Inc
• Revive Psycho Therapy LLC
• Revolution Medical Supply
• Stephanie Lynn Revoredo
• Rex Medical P.C.

• Physical Therapy Clinic/Center in Bronx, NY
• Providers in Bronx, NY by specialty
• Physical Therapy Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.