Provider Demographics
NPI:1073100764
Name:EVOLUTION THERAPY IN MOTION, PLLC
Entity Type:Organization
Organization Name:EVOLUTION THERAPY IN MOTION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOBY
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:281-915-9632
Mailing Address - Street 1:2525 BARRY ROSE RD APT 1205
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-4607
Mailing Address - Country:US
Mailing Address - Phone:281-915-9632
Mailing Address - Fax:281-519-7845
Practice Address - Street 1:2525 BARRY ROSE RD APT 1205
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4607
Practice Address - Country:US
Practice Address - Phone:281-915-9632
Practice Address - Fax:281-519-7845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty