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General NPI Number Information
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NPI Number | 1972798007
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Entity Type | Organization
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Legal Business Name | REVOLUTION INCORPORATED
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 5310 YADKIN RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-3255
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Country | US
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Telephone | 910-988-6974
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Fax | 910-425-4956
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Provider Business Mailing Address
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Address Line | 5310 YADKIN RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28303-3255
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Country | US
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Telephone | 910-988-6974
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Fax | 910-425-4956
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL OPERATIONS
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Name | TREMAYNE THURMAN
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Credential |
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Telephone | 910-401-9210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 5574
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 9225
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License Number State | NC
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