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Organization
REVOLUTION PTWL LLC
Active
Organization
REVOLUTION PTWL LLC
Active
Other names
Revolution Physical Therapy Weight Loss
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RANDOLPH FRIESER (PRESIDENT)
(312) 878-8800
Entity
Organization
Contact information
Practice address
845 N MICHIGAN AVE, SUITE 973W, CHICAGO, IL 60611
(312) 878-8800
(312) 448-9978
Mailing address
845 N MICHIGAN AVE, SUITE 973W, CHICAGO, IL 60611-2252
(312) 878-8800
(312) 448-9978
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
133V00000X
Registered Dietitian
—
—
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
11/21/2012
Last updated
06/06/2018
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