Revival Physical Therapy Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

REVIVAL PHYSICAL THERAPY INC

Practice address

2301 Park Ave Ste 1
Orange Park, FL 32073-5565

Phone

(904) 264-3005

Fax

(904) 264-0012

NPI assigned

May 18, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Linzy E. Garcia, RPT

Title

Clinical Director/ Owner

Phone

(904) 264-3005

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Outpatient physical therapy / speech pathology certification: CCN 686521

Legal name

REVIVAL PHYSICAL THERAPY

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Oct 8, 1997

Last certification

Aug 29, 2019

Ownership / control type

Proprietary

Facility address

2301 Park Ave Ste 201
Orange Park, FL 32073

Locations

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688947200000",
    "number": "1841243359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 PARK AVE STE 1",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320735565",
            "telephone_number": "904-264-3005",
            "fax_number": "904-264-0012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 PARK AVE STE 1",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320735565",
            "telephone_number": "904-264-3005",
            "fax_number": "904-264-0012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVAL PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "LINZY",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR/ OWNER",
        "authorized_official_telephone_number": "904-264-3005",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "884338400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fabienne Rocher Rene, ARNP
• Martine Renelus
• Kimberly Villarreal Renner, OTR/L
• Pia S Rentoy, PT
• Reuben Maggard M.D. P.a.
• Sina Rezaie, MD
• Nicole Christine Rhiner
• Chemere Rhinhart
• Idallis Rhodes
• Muhammad Nauman Riaz, M.D.

• Physical Therapist in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.