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General NPI Number Information
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NPI Number | 1861082257
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Entity Type | Organization
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Legal Business Name | REVOLUTION PERFORMANCE PHYSICAL THERAPY
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Dates
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Enumeration Date | 01/20/2021
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Last Update Date | 01/20/2021
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Provider Practice Location Address
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Address Line | 4906 W 35TH ST
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-2612
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Country | US
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Telephone | 507-459-2722
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Fax |
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Provider Business Mailing Address
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Address Line | 18954 EMBRY AVE
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City | FARMINGTON
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State | MN
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Zip | 55024-7007
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Country | US
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Telephone | 507-459-2272
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | CHRISTOPHER MEYER
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Credential | PT
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Telephone | 507-459-2272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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