Revolution Physical Therapy PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

REVOLUTION PHYSICAL THERAPY PLLC

Practice address

115 W 30TH St RM 502
New York, NY 10001-4074

Phone

(631) 213-2394

Fax

(212) 898-0470

NPI assigned

Sep 30, 2020

Last updated

Dec 9, 2024By 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

Kenneth Chang-Hay Van, DPTNPI 1275721524

Title

Owner

Phone

(917) 816-0691

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NY

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, and the practitioner matching its NPPES authorized official.

• Kenneth Chang-Hay Van, PT, DPT

  • Physical Therapist
  • New York, NY
  • NPI 1275721524
  Medicare reassignment Care Compare group NPD Authorized official
• Kristina Phu, DPT

  • Physical Therapist
  • New York, NY
  • NPI 1548761596
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1601424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733702400000",
    "number": "1689281842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 W 30TH ST RM 502",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100014074",
            "telephone_number": "631-231-2394",
            "fax_number": "212-898-0470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 W 30TH ST RM 502",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100014074",
            "telephone_number": "631-213-2394",
            "fax_number": "212-898-0470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTION PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-30",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A",
        "authorized_official_last_name": "VAN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "CHANG-HAY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-816-0691",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1275721524",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kvan@revolutionpt.net",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "115 W 30th St Rm 502",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100014074",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Shaquiana Grace Revels
• Christopher Michael Reverte, MD
• Revibe Health Systems
• Alejandro Revilla Montag, MD
• Revolution Physical Therapy Nyc PLLC
• Revolve Physical Therapy PLLC
• Inna Revutsky
• Rewind Time Fitness LLC
• Eva Rex Vogel, LCSW, MSW
• Rex Wu,MD.PLLC

• Physical Therapist in New York, NY
• Providers in New York, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 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.