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Organization
REVOLUTION THERAPY & FITNESS LLC
Active
Organization
REVOLUTION THERAPY & FITNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LLEWELLYN SEAN WORSHAM (OCCUPATIONAL THERAPY ASSISTANT)
(843) 323-0174
Entity
Organization
Contact information
Practice address
8626 DORCHESTER RD STE 103, NORTH CHARLESTON, SC 29420-7328
(843) 964-4996
(888) 856-3189
Mailing address
215 BLOSSOM ST, GOOSE CREEK, SC 29445-3516
(843) 323-0174
(888) 856-3189
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
NULL
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
Primary
—
NULL
225100000X
Physical Therapist
Primary
—
—
225200000X
Physical Therapy Assistant
—
NULL
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
—
NULL
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP7597
—
SC
Enumeration date
05/05/2016
Last updated
08/24/2020
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