NPIMap

Organization Active NPI

PT Revolution Physical Therapy, PC

  • Physical Therapy Clinic/Center
  • South Lake Tahoe, CA
National Provider Identifier
1467179663
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
PT REVOLUTION PHYSICAL THERAPY, PC
Practice address
2038 Lake Tahoe Blvd
South Lake Tahoe, CA 96150-6499
Phone
(530) 208-9910
Fax
(530) 285-2001
NPI assigned
Oct 27, 2022
Last updated
Apr 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2023

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

Authorized official

Name
Jason CollinNPI 1366403933
Title
Owner
Phone
(530) 307-3316

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU Primary

Addresses

Primary practice location

2038 Lake Tahoe Blvd
South Lake Tahoe, CA 96150-6499

Mailing address

2038 Lake Tahoe Blvd
South Lake Tahoe, CA 96150-6499
Phone (530) 208-9910

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jason@ptrevolution.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230711000737 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5092174987 Receives reassigned benefits from 12 practitioners
Practice locations: South Lake Tahoe, CA; Truckee, CA

National Provider Directory

National Provider Directory

Locations

2038 Lake Tahoe Blvd
South Lake Tahoe, CA 96150
Phone (530) 208-9910

40173 Truckee Airport Rd
Ste 102
Truckee, CA 96161
Phone (530) 999-5787

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1666828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682467200000",
    "number": "1467179663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2038 LAKE TAHOE BLVD",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961506499",
            "telephone_number": "530-208-9910",
            "fax_number": "530-285-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2038 LAKE TAHOE BLVD",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961506499",
            "telephone_number": "530-208-9910",
            "fax_number": "530-285-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PT REVOLUTION PHYSICAL THERAPY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-27",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A",
        "authorized_official_last_name": "COLLIN",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "530-307-3316"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jason@ptrevolution.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2038 Lake Tahoe Blvd",
            "city": "South Lake Tahoe",
            "state": "CA",
            "country_code": "US",
            "postal_code": "961506499",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in South Lake Tahoe, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2023; 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.