# REVOLUTION THERAPY & FITNESS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1427404730
- **Authorized official:** LLEWELLYN SEAN WORSHAM (OCCUPATIONAL THERAPY ASSISTANT)
- **Authorized official phone:** (843) 323-0174

## Contact information

- **Practice address:** 8626 DORCHESTER RD STE 103, NORTH CHARLESTON, SC 29420-7328
- **Practice address phone:** (843) 964-4996
- **Practice address fax:** (888) 856-3189
- **Mailing address:** 215 BLOSSOM ST, GOOSE CREEK, SC 29445-3516
- **Mailing address phone:** (843) 323-0174
- **Mailing address fax:** (888) 856-3189

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 224Z00000X | Occupational Therapy Assistant | — | NULL | — |
| 224Z00000X | Occupational Therapy Assistant | — | — | — |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |
| 225200000X | Physical Therapy Assistant | — | NULL | — |
| 225200000X | Physical Therapy Assistant | — | — | — |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |

## Other

- **Enumeration date:** 05/05/2016
- **Last updated:** 08/24/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GP7597 | — | SC |