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General NPI Number Information
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NPI Number | 1932498649
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Entity Type | Organization
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Legal Business Name | REVAMP THERAPY L.L.C.
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Dates
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Enumeration Date | 04/04/2011
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Last Update Date | 04/18/2011
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Provider Practice Location Address
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Address Line | 1935 SAN MARIE DR N
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2348
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Country | US
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Telephone | 352-226-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 1935 SAN MARIE DR N
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2348
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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 | MANAGER/PHYSICAL THERAPIST
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Name | NASH BUTRIMAS
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Credential |
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Telephone | 352-226-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | PT222863
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License Number State | FL
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