Revive Health & Wellness

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05004967A Issued in IN

Legal business name

REVIVE HEALTH & WELLNESS

Practice address

3541 Paoli Pike
Floyds Knobs, IN 47119-9751

Phone

(502) 387-7783

Fax

(812) 941-0198

NPI assigned

Feb 24, 2012

Last updated

Feb 24, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Malissa ThompsonNPI 1376612341

Title

MPT/Owner

Phone

(502) 387-7783

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Malissa Thompson, MPT

  • Physical Therapist
  • Floyds Knobs, IN
  • NPI 1376612341
  NPD (past) Authorized official

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

{
    "created_epoch": "1330041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330041600000",
    "number": "1508130345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4213 STONE MOUNTAIN RD",
            "city": "NEW ALBANY",
            "state": "IN",
            "postal_code": "471509233",
            "telephone_number": "502-387-7783",
            "fax_number": "812-941-0198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3541 PAOLI PIKE",
            "city": "FLOYDS KNOBS",
            "state": "IN",
            "postal_code": "471199751",
            "telephone_number": "502-387-7783",
            "fax_number": "812-941-0198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE HEALTH & WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-24",
        "last_updated": "2012-02-24",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "MALISSA",
        "authorized_official_title_or_position": "MPT/OWNER",
        "authorized_official_telephone_number": "502-387-7783"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05004967A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Floyds Knobs, IN
• Providers in Floyds Knobs, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2012; 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.