Provider Demographics
NPI:1003189408
Name:EVOLVE MASSAGE
Entity Type:Organization
Organization Name:EVOLVE MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILHELM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1406-388-9915
Mailing Address - Street 1:8757 JACKRABBIT LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-7900
Mailing Address - Country:US
Mailing Address - Phone:140-638-8311
Mailing Address - Fax:
Practice Address - Street 1:8757 JACKRABBIT LN
Practice Address - Street 2:SUITE C
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-7900
Practice Address - Country:US
Practice Address - Phone:140-638-8311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization