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General NPI Number Information
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NPI Number | 1821596586
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Entity Type | Organization
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Legal Business Name | REVOLUTION PHYSICAL THERAPY NYC PLLC
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Dates
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Enumeration Date | 01/29/2018
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Last Update Date | 01/29/2018
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Provider Practice Location Address
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Address Line | 165 BROADWAY FL 23
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City | NEW YORK
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State | NY
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Zip | 10006-1404
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Country | US
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Telephone | 917-922-2682
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Fax |
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Provider Business Mailing Address
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Address Line | 893 MYRTLE AVE
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City | BROOKLYN
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State | NY
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Zip | 11206-6654
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Country | US
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Telephone | 917-922-2682
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | LORAINE ANTOINE
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Credential | PT, DPT
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Telephone | 917-363-6433
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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 | 016510
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 029251
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License Number State | NY
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