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General NPI Number Information
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NPI Number | 1891481396
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Entity Type | Organization
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Legal Business Name | REVO PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 04/17/2023
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 1999 PLAINFIELD PIKE
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City | JOHNSTON
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State | RI
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Zip | 02919-5725
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Country | US
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Telephone | 401-575-8893
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Fax | 401-232-8061
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Provider Business Mailing Address
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Address Line | 1999 PLAINFIELD PIKE
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City | JOHNSTON
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State | RI
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Zip | 02919-5725
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Country | US
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Telephone | 401-575-8893
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Fax | 401-232-8061
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Authorized Official
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Title or Position | OWNER
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Name | RYAN TOHER
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Credential | PT, DPT
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Telephone | 401-829-0890
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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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