Provider Demographics
NPI:1164921862
Name:REVOLUTION INCORPORATED
Entity Type:Organization
Organization Name:REVOLUTION INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TREMAYNE
Authorized Official - Middle Name:T
Authorized Official - Last Name:THURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:AS, MRS, OTR/L
Authorized Official - Phone:910-491-5164
Mailing Address - Street 1:5310 YADKIN RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-3255
Mailing Address - Country:US
Mailing Address - Phone:910-491-5164
Mailing Address - Fax:910-229-3227
Practice Address - Street 1:5860 YADKIN RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-2668
Practice Address - Country:US
Practice Address - Phone:910-491-5164
Practice Address - Fax:910-229-3227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-08
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9225225100000X
NC5574225X00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty