# REVOLUTION REHABILITATION AND SPORTS PERFORAMANCE LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Revolution Rehab
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720471345
- **Authorized official:** DR. MATTHEW SEAN BOURDEAU DPT (PHYSICAL THERAPIST)
- **Authorized official phone:** (301) 848-2284

## Contact information

- **Practice address:** 1100 RUSSELL ST, BALTIMORE, MD 21230-2622
- **Practice address phone:** (301) 848-2284
- **Mailing address:** 2653 CEDAR ELM DR, ODENTON, MD 21113-2905
- **Mailing address phone:** (301) 848-2284

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2000X | Physical Therapy Clinic/Center | 23944 | MD | — |
| 261QP2000X | Physical Therapy Clinic/Center | 24069 | MD | Yes |

## Other

- **Enumeration date:** 03/05/2015
- **Last updated:** 04/02/2015