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General NPI Number Information
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NPI Number | 1962125534
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Entity Type | Organization
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Legal Business Name | REVOLUTION REHAB LLC
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Dates
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Enumeration Date | 09/20/2022
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 4981 PLAINFIELD AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-1076
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Country | US
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Telephone | 616-344-4469
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Fax |
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Provider Business Mailing Address
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Address Line | 2029 ROGUE RIVER RD NE
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City | BELMONT
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State | MI
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Zip | 49306-9790
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Country | US
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Telephone | 616-334-4469
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TYLER KINCH
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Credential | DPT
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Telephone | 586-453-5279
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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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