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Organization
REVOLUTIONARY PHYSICAL THERAPY INC.
Active
Organization
REVOLUTIONARY PHYSICAL THERAPY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL MERCADO (OWNER/PRESIDENT)
(201) 667-6971
Entity
Organization
Contact information
Practice address
60 GARDEN ST, LITTLE FERRY, NJ 07643-1535
(201) 667-6971
Mailing address
60 GARDEN ST, LITTLE FERRY, NJ 07643-1535
(201) 667-6971
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40QA00805300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
40QA00805300
PHYSICAL THERAPY LICENSE
NJ
Enumeration date
09/12/2012
Last updated
09/12/2012
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