Revolution Physical Therapy LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

REVOLUTION PHYSICAL THERAPY LLC

Practice address

5847 Getwell Rd Ste A5
Southaven, MS 38672-6816

Phone

(662) 349-9288

Fax

(662) 349-9289

NPI assigned

Mar 1, 2018

Last updated

Apr 29, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Amy Graham, DPTNPI 1467410969

Title

Owner

Phone

(662) 349-9288

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

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, and the practitioner matching its NPPES authorized official.

• Amy Renae Graham, DPT

  • Physical Therapist
  • Southaven, MS
  • NPI 1467410969
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1519862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777420800000",
    "number": "1518469063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5847 GETWELL RD STE A5",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386726816",
            "telephone_number": "662-349-9288",
            "fax_number": "662-349-9289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5847 GETWELL RD STE A5",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386726816",
            "telephone_number": "662-349-9288",
            "fax_number": "662-349-9289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTION PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-01",
        "last_updated": "2026-04-29",
        "certification_date": "2026-04-29",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-349-9288",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Southaven, MS
• Providers in Southaven, MS by specialty
• Physical Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2026; 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.