Revolutionary Rehab Wellness Corp

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

40QA00805300 Issued in NJ

Legal business name

REVOLUTIONARY REHAB WELLNESS CORP

Practice address

138 Park Ave
East Rutherford, NJ 07073-1855

Phone

(201) 438-4400

Fax

(201) 203-1748

NPI assigned

Jun 12, 2014

Last updated

Jun 12, 2014By 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

Mr. Daniel Mercado, PT

Title

President

Phone

(201) 438-4400

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1402531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402531200000",
    "number": "1659785061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 PARK AVE",
            "city": "EAST RUTHERFORD",
            "state": "NJ",
            "postal_code": "070731855",
            "telephone_number": "201-438-4400",
            "fax_number": "201-203-1748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 PARK AVE",
            "city": "EAST RUTHERFORD",
            "state": "NJ",
            "postal_code": "070731855",
            "telephone_number": "201-438-4400",
            "fax_number": "201-203-1748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTIONARY REHAB WELLNESS CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-12",
        "last_updated": "2014-06-12",
        "status": "A",
        "authorized_official_last_name": "MERCADO",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-438-4400",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NJ",
            "license": "40QA00805300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Clinic/Center in East Rutherford, NJ
• Providers in East Rutherford, NJ by specialty
• Physical Therapy Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2014; 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.