Provider Demographics
NPI:1164014635
Name:EVOLVE PHYSICAL THERAPY AND PERSONAL FITNESS LLC
Entity Type:Organization
Organization Name:EVOLVE PHYSICAL THERAPY AND PERSONAL FITNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:207-712-0427
Mailing Address - Street 1:32 C ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-4703
Mailing Address - Country:US
Mailing Address - Phone:207-712-0427
Mailing Address - Fax:
Practice Address - Street 1:32 C ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-4703
Practice Address - Country:US
Practice Address - Phone:207-712-0427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-06
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty