Revolution Therapy & Fitness LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

REVOLUTION THERAPY & FITNESS LLC

Practice address

8626 Dorchester Rd Ste 103
North Charleston, SC 29420-7328

Phone

(843) 964-4996

Fax

(888) 856-3189

NPI assigned

May 5, 2016

Organization subpart

No

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

Authorized official

Name

Llewellyn Sean WorshamNPI 1295184299

Title

Occupational Therapy Assistant

Phone

(843) 323-0174

Specialties & licenses 4

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Llewellyn Worsham, COTA/L

  • Occupational Therapy Assistant
  • Goose Creek, SC
  • NPI 1295184299
  NPD Authorized official

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

{
    "created_epoch": "1462406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598227200000",
    "number": "1427404730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 BLOSSOM ST",
            "city": "GOOSE CREEK",
            "state": "SC",
            "postal_code": "294453516",
            "telephone_number": "843-323-0174",
            "fax_number": "888-856-3189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8626 DORCHESTER RD STE 103",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294207328",
            "telephone_number": "843-964-4996",
            "fax_number": "888-856-3189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTION THERAPY & FITNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-05",
        "last_updated": "2020-08-24",
        "certification_date": "2020-08-24",
        "status": "A",
        "authorized_official_last_name": "WORSHAM",
        "authorized_official_first_name": "LLEWELLYN",
        "authorized_official_middle_name": "SEAN",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPY ASSISTANT",
        "authorized_official_telephone_number": "843-323-0174"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP7597",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Resource Medical Group of Charleston, LLC
• Restore PT
• Resurrection Health
• Ashlee Revell, LAT,ATC
• Carrie Reville, C.N.M.
• Revolve Performance Rehab
• Lesley Reyes, DNP, FNP-C
• Walesca Reyes, SLP
• Linda E Reynolds, CCC-SLP
• Linda Susan Reynolds, O.D.

• Physical Therapist in North Charleston, SC
• Providers in North Charleston, SC by specialty
• Physical Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.