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General NPI Number Information
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NPI Number | 1801257464
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Entity Type | Organization
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Legal Business Name | REVOLUTION PHYSICAL THERAPY
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Dates
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Enumeration Date | 03/10/2016
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 2705 DOUGHERTY FERRY RD STE. 104
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City | SAINT LOUIS
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State | MO
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Zip | 63122-3371
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Country | US
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Telephone | 314-394-3319
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Fax |
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Provider Business Mailing Address
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Address Line | 15 APEX DR
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City | HIGHLAND
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State | IL
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Zip | 62249-1282
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGING PARTNER
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Name | AARON MCBRIDE
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Credential |
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Telephone | 314-394-3319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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