Provider Demographics
NPI:1023671625
Name:REVERVE LLC
Entity type:Organization
Organization Name:REVERVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-669-6927
Mailing Address - Street 1:114 ALASKA WAY S
Mailing Address - Street 2:SUITE 506
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104
Mailing Address - Country:US
Mailing Address - Phone:206-487-3391
Mailing Address - Fax:866-264-3391
Practice Address - Street 1:114 ALASKAN WAY S APT 506
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2585
Practice Address - Country:US
Practice Address - Phone:206-487-3391
Practice Address - Fax:866-264-3391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-18
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT60468708OtherWASHINGTON STATE DOL PHYSICAL THERAPY