| Organization Name: | REVERT LLC |
| NPI Number: | 1568857118 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BARON EDWARD DUFFY (MANAGING MEMBER) |
| Mailing Address: | 181 Goeletta Dr East Falmouth |
| State: | MA US |
| Postal Code: | 025363968 |
| Phone Number: | 5085348693 |
| Fax Number: | 5084372597 |
| NPI Enumeration Date: | 03/31/2015 |
| NPI Last Update Date: | 03/31/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |