MEDICARE: REVOLVE PHYSICAL THERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1972375731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVOLVE PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	75 MAIDEN LN RM 404
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10038-4636
Country	:	US
Telephone Number	:	917-455-4881
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 MAIDEN LN RM 404
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10038-4636
Country	:	US
Telephone Number	:	917-455-4881
Fax Number	:	866-648-7828

Authorized Official
Title or Position	:	OWNER
Name	:	BRIANNA ARJONA
Credential	:	DPT
Telephone Number	:	917-455-4881

Provider Enumeration Date	:	10/25/2023
Last Update Date	:	10/25/2023

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