MEDICARE: REVOLUTION REHABILITATION P. C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center	5237	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C806977	OTHER	CO	MEDICARE PTAN

General Provider Information

NPI Number	:	1578626248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVOLUTION REHABILITATION P. C.

Provider Business Mailing Address
First Line	:	155 PRINTERS PKWY
Second Line	:	SUITE 125
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-6100
Country	:	US
Telephone Number	:	719-635-8622
Fax Number	:	719-635-8619

Provider Business Practice Location Address
First Line	:	155 PRINTERS PKWY
Second Line	:	SUITE 125
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-6100
Country	:	US
Telephone Number	:	719-635-8622
Fax Number	:	719-635-8619

Authorized Official
Title or Position	:	OWNER
Name	:	KAMBER LEE ARBINI
Credential	:
Telephone Number	:	719-635-8622

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	01/09/2025

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