Individual
ROBERT JOHN REVOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
2200 STONY BROOK DR, LOUISVILLE, KY 40220-4016
(502) 495-6240
Mailing address
11204 COVENTRY GREENS DR, LOUISVILLE, KY 40241-3409
(502) 708-1124
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
A00571
KY
Other
Enumeration date
01/23/2012
Last updated
01/23/2012
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