Provider Demographics
NPI:1750930004
Name:REVOLUTIONS PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:REVOLUTIONS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLBIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:JORGENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:435-632-3764
Mailing Address - Street 1:8751 SW PAMLICO CT
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9345
Mailing Address - Country:US
Mailing Address - Phone:435-632-3764
Mailing Address - Fax:
Practice Address - Street 1:8751 SW PAMLICO CT
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9345
Practice Address - Country:US
Practice Address - Phone:435-632-3764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy