Provider Demographics
NPI:1407571292
Name:EVOLVING GAIT PHYSICAL THERAPY
Entity Type:Organization
Organization Name:EVOLVING GAIT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDSAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-320-1111
Mailing Address - Street 1:12 PLATINUM CT
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-2247
Mailing Address - Country:US
Mailing Address - Phone:631-320-1111
Mailing Address - Fax:631-314-4502
Practice Address - Street 1:12 PLATINUM CT
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-2247
Practice Address - Country:US
Practice Address - Phone:631-320-1111
Practice Address - Fax:631-314-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty