Provider Demographics
NPI:1184209801
Name:EVO PHYSICAL THERAPY & PERFORMANCE LLC
Entity Type:Organization
Organization Name:EVO PHYSICAL THERAPY & PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:212-421-1969
Mailing Address - Street 1:795 TUNNEY POINT DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-4788
Mailing Address - Country:US
Mailing Address - Phone:908-692-7624
Mailing Address - Fax:212-223-0198
Practice Address - Street 1:795 TUNNEY POINT DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-4788
Practice Address - Country:US
Practice Address - Phone:908-692-7624
Practice Address - Fax:212-223-0198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty