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General NPI Number Information
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NPI Number | 1952983454
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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 | 04/23/2021
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Last Update Date | 04/23/2021
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Provider Practice Location Address
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Address Line | 5253 MAGELLAN WAY W
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City | DELRAY BEACH
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State | FL
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Zip | 33484-1358
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Country | US
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Telephone | 772-486-0414
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Fax |
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Provider Business Mailing Address
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Address Line | 5253 MAGELLAN WAY W
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City | DELRAY BEACH
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State | FL
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Zip | 33484-1358
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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/PHYSICAL THERAPIST
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Name | WILLIAM TYSON YOUNG JR.
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Credential | DPT
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Telephone | 772-486-0414
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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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