| Revive Pelvic Health & Physical Therapy Llc | |
|
107 Victoria Ln Clinton MS 39056-4031 | |
| (601) 953-6876 | |
| Not Available |
| Full Name | Revive Pelvic Health & Physical Therapy Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 107 Victoria Ln, Clinton, Mississippi |
| Authorized Official Name and Position | Veronica Barton (CEO) |
| Authorized Official Contact | 6019536876 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Revive Pelvic Health & Physical Therapy Llc 107 Victoria Ln Clinton MS 39056-4031 Ph: (601) 953-6876 | Revive Pelvic Health & Physical Therapy Llc 107 Victoria Ln Clinton MS 39056-4031 Ph: (601) 953-6876 |
| NPI Number | 1689266009 |
|---|---|
| Provider Enumeration Date | 02/08/2021 |
| Last Update Date | 02/08/2021 |
| Medicare PECOS PAC ID | 3375925365 |
|---|---|
| Medicare Enrollment ID | O20220808002832 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689266009 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QP2000X | Clinic/center - Physical Therapy | (* (Not Available)) | Primary |
| Provider Name | Veronica Woodson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1508346222 PECOS PAC ID: 0547642530 Enrollment ID: I20220808002862 |
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