Revolutionary Physical Therapy Inc.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

40QA00805300 Issued in NJ

Legal business name

REVOLUTIONARY PHYSICAL THERAPY INC.

Practice address

60 Garden St
Little Ferry, NJ 07643-1535

Phone

(201) 667-6971

NPI assigned

Sep 12, 2012

Organization subpart

No

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

Authorized official

Name

Daniel Mercado

Title

Owner/President

Phone

(201) 667-6971

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1347408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347408000000",
    "number": "1578813994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 GARDEN ST",
            "city": "LITTLE FERRY",
            "state": "NJ",
            "postal_code": "076431535",
            "telephone_number": "201-667-6971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 GARDEN ST",
            "city": "LITTLE FERRY",
            "state": "NJ",
            "postal_code": "076431535",
            "telephone_number": "201-667-6971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTIONARY PHYSICAL THERAPY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-12",
        "last_updated": "2012-09-12",
        "status": "A",
        "authorized_official_last_name": "MERCADO",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "201-667-6971"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "40QA00805300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPY LICENSE",
            "identifier": "40QA00805300",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Little Ferry, NJ
• Providers in Little Ferry, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2012; 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.