Provider Demographics
NPI:1487032892
Name:REVOLUTIONS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:REVOLUTIONS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPITZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-393-1655
Mailing Address - Street 1:30 SUDBURY RD STE 2
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-5954
Mailing Address - Country:US
Mailing Address - Phone:978-393-1655
Mailing Address - Fax:
Practice Address - Street 1:158 CONCORD RD
Practice Address - Street 2:APT H23
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-4609
Practice Address - Country:US
Practice Address - Phone:978-505-7219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19380261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110099789AMedicaid
MA110099789AMedicaid