Provider Demographics
NPI:1417307307
Name:EVOLVE PT, LLC
Entity Type:Organization
Organization Name:EVOLVE PT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:ENMANUEL
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:305-588-9064
Mailing Address - Street 1:253 NE 2ND ST APT 2208
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-2294
Mailing Address - Country:US
Mailing Address - Phone:305-588-9064
Mailing Address - Fax:
Practice Address - Street 1:18001 COLLINS AVE
Practice Address - Street 2:2ND FLOOR SPA
Practice Address - City:SUNNY ISLES BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-2722
Practice Address - Country:US
Practice Address - Phone:786-777-8828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X, 261QR0400X
FLPT28676261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation