Revive Physical Therapy, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

REVIVE PHYSICAL THERAPY, LLC

Practice address

12550 Airline Hwy Ste 102
Gonzales, LA 70737-2269

Phone

(985) 703-2412

NPI assigned

Jan 29, 2018

Organization subpart

No

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

Authorized official

Name

Tanya Broussard

Title

Credentialing Specialist

Phone

(337) 704-5611

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Locations

Practitioners 1

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

• Jeremy Calvin Catoire, DPT

  • Physical Therapist
  • Baton Rouge, LA
  • NPI 1033469051
  Medicare reassignment NPD

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

{
    "created_epoch": "1517184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517184000000",
    "number": "1982102620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3261 EFFIE RD",
            "city": "HESTER",
            "state": "LA",
            "postal_code": "70743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12550 AIRLINE HWY STE 102",
            "city": "GONZALES",
            "state": "LA",
            "postal_code": "707372269",
            "telephone_number": "985-703-2412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-29",
        "last_updated": "2018-01-29",
        "status": "A",
        "authorized_official_last_name": "BROUSSARD",
        "authorized_official_first_name": "TANYA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "337-704-5611"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heidi Brignac Remondet
• Renewed Radiance
• Frances E Rensch, DDS
• Revive Again Support Coordination Services LLC
• Revive Again Therapeutic Services
• Trevor C. Richard, MD
• Nora Shipp Richardson-Foote, D.D.S.
• Camita Ricks
• Ryan D Rife, LCSW
• Kelanda Quezelda Riley, BS, MSW, RSW

• Physical Therapy Clinic/Center in Gonzales, LA
• Providers in Gonzales, LA by specialty
• Physical Therapy Clinic/Center in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2018; 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.