Revival Physical Therapy, LLC

Primary specialty

Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081H0002X

Legal business name

REVIVAL PHYSICAL THERAPY, LLC

Practice address

4116 Swindon CT
Charlotte, NC 28215-5355

Phone

(980) 230-3276

NPI assigned

Jun 10, 2019

Organization subpart

No

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

Authorized official

Name

Mitchell Samonte Montemayor, PT

Title

Ceo

Phone

(980) 276-3066

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1560124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560124800000",
    "number": "1518526953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4116 SWINDON CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282155355",
            "telephone_number": "980-230-3276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4116 SWINDON CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282155355",
            "telephone_number": "980-230-3276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVAL PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-10",
        "last_updated": "2019-06-10",
        "status": "A",
        "authorized_official_last_name": "MONTEMAYOR",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "SAMONTE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "980-276-3066",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "2081H0002X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terica Larae Revels, FNP-C
• Sheley Rene' Revis, MD
• Revision Counseling and Wellness, PLLC.
• Revitalize Psychiatry, PLLC
• Revival Functional Nutrition PLLC
• Revive Your Path Network
• Revolution Access LLC
• Rew Works Counseling Services, LLC
• Marsha R Rexford, CRNA
• Reyboze LLC

• Physical Medicine & Rehabilitation Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Physical Medicine & Rehabilitation Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2019; 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.