Provider Demographics
NPI:1477564599
Name:EVOLUTION HOME PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:EVOLUTION HOME PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LINDSAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:631-513-9475
Mailing Address - Street 1:7 WATERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1169
Mailing Address - Country:US
Mailing Address - Phone:631-513-9475
Mailing Address - Fax:631-689-5828
Practice Address - Street 1:7 WATERVIEW DR
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1169
Practice Address - Country:US
Practice Address - Phone:631-513-9475
Practice Address - Fax:631-689-5828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ7WGH1Medicare ID - Type Unspecified