Provider Demographics
NPI:1861231524
Name:REVOLUTION PHYSICAL THERAPY CORBIN
Entity type:Organization
Organization Name:REVOLUTION PHYSICAL THERAPY CORBIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-524-7818
Mailing Address - Street 1:195 COMMERICAL DR
Mailing Address - Street 2:STE 100
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744
Mailing Address - Country:US
Mailing Address - Phone:606-524-7818
Mailing Address - Fax:
Practice Address - Street 1:1480 CUMBERLAND FALLS HWY
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701
Practice Address - Country:US
Practice Address - Phone:606-524-7818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty