Revolution Orthotics & Prosthetics, LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

REVOLUTION ORTHOTICS & PROSTHETICS, LLC

Practice address

4 Meeting House Rd Unit 9&10
Chelmsford, MA 01824-2766

Phone

(351) 500-8065

Fax

(351) 500-8069

NPI assigned

Jul 30, 2024

Organization subpart

No

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

Authorized official

Name

Dylan A Miller, CPONPI 1861146987

Title

Owner

Phone

(407) 221-7810

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Locations

Practitioners 2

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

• Dylan A Miller, CO

  • Customized Equipment (DME)
  • Chelmsford, MA
  • NPI 1861146987
  NPD Authorized official
• Amanda Savoia Brown, CO

  • Orthotist
  • Charlotte, NC
  • NPI 1720733173
  NPD

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

{
    "created_epoch": "1722297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722297600000",
    "number": "1639908585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 MEETING HOUSE RD UNIT 9&10",
            "city": "CHELMSFORD",
            "state": "MA",
            "postal_code": "018242766",
            "telephone_number": "351-500-8065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 MEETING HOUSE RD UNIT 9&10",
            "city": "CHELMSFORD",
            "state": "MA",
            "postal_code": "018242766",
            "telephone_number": "351-500-8065",
            "fax_number": "351-500-8069"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTION ORTHOTICS & PROSTHETICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-30",
        "last_updated": "2024-07-30",
        "certification_date": "2024-07-30",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "DYLAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-221-7810",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Shirah Reiss, MS CCC-SLP
• Rekha Quazi, M.D. PC
• Celia M. Repucci, PT
• Restore Behavioral Health Clinic LLC
• Revolution Orthotics & Prosthetics, LLC
• Katherine Ellen Rice, NP
• Darian Rideout, BCBA
• Anne Ivy Riemer, PA-C
• Kayla Victoria Riendeau
• Nina Marie Riley

• Prosthetic/Orthotic Supplier in Chelmsford, MA
• Providers in Chelmsford, MA by specialty
• Prosthetic/Orthotic Supplier in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2024; 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.