Revolution Sports Medicine

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

REVOLUTION SPORTS MEDICINE

Practice address

6570 Dobbin Rd
Columbia, MD 21045-5855

Phone

(240) 512-0190

Fax

(240) 512-0192

NPI assigned

Jun 22, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Timothy P. Loughlin, DPTNPI 1700100476

Title

President

Phone

(240) 512-0190

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in RI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Timothy Paul Loughlin, DPT

  • Physical Therapist
  • Smithfield, RI
  • NPI 1700100476
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1434931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481673600000",
    "number": "1083096499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6570 DOBBIN RD",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210455855",
            "telephone_number": "240-512-0190",
            "fax_number": "240-512-0192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6570 DOBBIN RD",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210455855",
            "telephone_number": "240-512-0190",
            "fax_number": "240-512-0192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTION SPORTS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-22",
        "last_updated": "2016-12-14",
        "status": "A",
        "authorized_official_last_name": "LOUGHLIN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "240-512-0190",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Restore & Thrive LLC.
• Cristina Restrepo-Harner
• Revered-Holistic Healthcare LLC
• Revered-Holistic Healthcare LLC
• Revive Clinic LLC
• Jeanine Paulette Sioson Reyes-Bautista, M.D.
• Camila Reyes-Loayza
• Samantha Reyes
• Aahna Reynolds
• Kristen Mary Reynolds, RN

• Physical Therapist in Columbia, MD
• Providers in Columbia, MD by specialty
• Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.