Revolution Running Physical Therapy,PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

REVOLUTION RUNNING PHYSICAL THERAPY,PLLC

Practice address

971 Main St
Holbrook, NY 11741-1609

Phone

(516) 376-9202

NPI assigned

Jan 5, 2021

Organization subpart

No

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

Authorized official

Name

Natalie Niemczyk, DPTNPI 1568823037

Title

Owner

Phone

(516) 376-9202

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

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

• Natalie Niemczyk

  • Physical Therapist
  • East Patchogue, NY
  • NPI 1568823037
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1609804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614038400000",
    "number": "1982292900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "971 MAIN ST",
            "city": "HOLBROOK",
            "state": "NY",
            "postal_code": "117411609",
            "telephone_number": "516-376-9202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "971 MAIN ST",
            "city": "HOLBROOK",
            "state": "NY",
            "postal_code": "117411609",
            "telephone_number": "516-376-9202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTION RUNNING PHYSICAL THERAPY,PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-05",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A",
        "authorized_official_last_name": "NIEMCZYK",
        "authorized_official_first_name": "NATALIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-376-9202",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charlene E Raygada, RN
• Wendy K Reiersen, RN
• Debra Anne Reilly, PNP
• Annmarie Reiszel, RN
• Kathy Anne Resasco, LMT
• Charina Cailles Reyes, P.T.
• Francisco Albert Rojas Reyes, P.T.
• Pamela Rice
• Jessica Riemenschneider, LPN
• Brendan Andrew Rini I

• Physical Therapist in Holbrook, NY
• Providers in Holbrook, 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 Feb 23, 2021; 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.