# REVOLUTION PHYSICAL THERAPY WEIGHT LOSS

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

## Provider details

- **NPI number:** 1922454255
- **Authorized official:** KATRINA WYSZOMIRSKI-CORN (MANAGER OF OFFICE OPERATIONS)
- **Authorized official phone:** (312) 878-8800

## Contact information

- **Practice address:** 205 N. WELLS ST., CHICAGO, IL 60606
- **Practice address phone:** (312) 878-8800
- **Mailing address:** 211 W WACKER DR, CHICAGO, IL 60606-1217
- **Mailing address phone:** (312) 878-8800

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 164006766 | IL | Yes |

## Other

- **Enumeration date:** 05/05/2016
- **Last updated:** 05/05/2016