Organization
REVOLUTION SPORT & SPINE THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK CUNNINGHAM PT (CEO)
(907) 420-0836
Entity
Organization
Contact information
Practice address
35249 KENAI SPUR HWY, SUITE C, SOLDOTNA, AK 99669-7623
(541) 913-3089
Mailing address
35249 KENAI SPUR HWY, SUITE C, SOLDOTNA, AK 99669-7623
(907) 420-0836
(907) 420-0837
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
1042783
AK
Other
Enumeration date
10/07/2016
Last updated
06/10/2017
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