Revivo Massage LLC

Primary specialty

Massage TherapistTaxonomy code 225700000X

Legal business name

REVIVO MASSAGE LLC

Practice address

226 Massachusetts Ave
Arlington, MA 02474-8435

Phone

(617) 752-1710

NPI assigned

May 22, 2025

Organization subpart

No

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

Authorized official

Name

Jamal Theodat

Title

Owner

Phone

(617) 504-2262

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1747872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747872000000",
    "number": "1437941556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 GROVE ST",
            "city": "MELROSE",
            "state": "MA",
            "postal_code": "021764631",
            "telephone_number": "617-504-2262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "226 MASSACHUSETTS AVE",
            "city": "ARLINGTON",
            "state": "MA",
            "postal_code": "024748435",
            "telephone_number": "617-752-1710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVO MASSAGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-22",
        "last_updated": "2025-05-22",
        "certification_date": "2025-05-22",
        "status": "A",
        "authorized_official_last_name": "THEODAT",
        "authorized_official_first_name": "JAMAL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-504-2262"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2025; 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.