Revolution Rehabilitation and Sports Perforamance LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

24069 Issued in MD

Legal business name

REVOLUTION REHABILITATION AND SPORTS PERFORAMANCE LLC

Doing business as

Revolution Rehab

Practice address

1100 Russell St
Baltimore, MD 21230-2622

Phone

(301) 848-2284

NPI assigned

Mar 5, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Matthew Sean Bourdeau, DPT

Title

Physical Therapist

Phone

(301) 848-2284

Specialties & licenses 2

Addresses

Other names 1

• Revolution Rehab Doing business as

Locations

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

{
    "created_epoch": "1425513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427932800000",
    "number": "1720471345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2653 CEDAR ELM DR",
            "city": "ODENTON",
            "state": "MD",
            "postal_code": "211132905",
            "telephone_number": "301-848-2284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 RUSSELL ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212302622",
            "telephone_number": "301-848-2284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTION REHABILITATION AND SPORTS PERFORAMANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-05",
        "last_updated": "2015-04-02",
        "status": "A",
        "authorized_official_last_name": "BOURDEAU",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "SEAN",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "301-848-2284",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MD",
            "license": "24069",
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MD",
            "license": "23944",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revolution Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Physical Therapy Clinic/Center in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Physical Therapy Clinic/Center in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2015; 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.