Provider Demographics
NPI:1891481396
Name:REVO PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:REVO PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:401-829-0890
Mailing Address - Street 1:1999 PLAINFIELD PIKE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-5725
Mailing Address - Country:US
Mailing Address - Phone:401-575-8893
Mailing Address - Fax:401-232-8061
Practice Address - Street 1:1999 PLAINFIELD PIKE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-5725
Practice Address - Country:US
Practice Address - Phone:401-575-8893
Practice Address - Fax:401-232-8061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty