| Organization Name: | REVOLUTIONARY REHAB WELLNESS CORP |
| NPI Number: | 1659785061 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DANIEL MERCADO (PRESIDENT) |
| Mailing Address: | 138 Park Ave East Rutherford |
| State: | NJ US |
| Postal Code: | 070731855 |
| Phone Number: | 2014384400 |
| Fax Number: | 2012031748 |
| NPI Enumeration Date: | 06/12/2014 |
| NPI Last Update Date: | 06/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 40QA00805300 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |