Provider Demographics
NPI:1376066514
Name:EVOLVE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:EVOLVE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARISSA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHAPNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:917-509-6776
Mailing Address - Street 1:516 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LKS
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1310
Mailing Address - Country:US
Mailing Address - Phone:917-509-6776
Mailing Address - Fax:
Practice Address - Street 1:516 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN LKS
Practice Address - State:NJ
Practice Address - Zip Code:07417-1310
Practice Address - Country:US
Practice Address - Phone:917-509-6776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01668600261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy