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Organization
REVOLUTION PHYSICAL THERAPY PLLC
Active
Organization
REVOLUTION PHYSICAL THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH CHANG-HAY VAN DPT (OWNER)
(917) 816-0691
Entity
Organization
Contact information
Practice address
115 W 30TH ST RM 502, NEW YORK, NY 10001-4074
(631) 213-2394
(212) 898-0470
Mailing address
115 W 30TH ST RM 502, NEW YORK, NY 10001-4074
(631) 231-2394
(212) 898-0470
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1275721524
NPI
NY
Enumeration date
09/30/2020
Last updated
12/09/2024
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