Provider Demographics
NPI:1568183101
Name:REVELLE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:REVELLE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:703-969-8226
Mailing Address - Street 1:7400 E ORCHARD RD # 280S
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2528
Mailing Address - Country:US
Mailing Address - Phone:303-323-9998
Mailing Address - Fax:833-770-4966
Practice Address - Street 1:7400 E ORCHARD RD STE 208S
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2575
Practice Address - Country:US
Practice Address - Phone:303-323-9998
Practice Address - Fax:833-770-4966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1568611986OtherNPI
GA1588059380OtherNPI
1356659627OtherNPI