Provider Demographics
NPI:1477900470
Name:EVOLUTION THERAPEUTICS LLC
Entity Type:Organization
Organization Name:EVOLUTION THERAPEUTICS LLC
Other - Org Name:EVOLUTION PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/COO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVVORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-551-6317
Mailing Address - Street 1:225 MAGILL DR
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01519-1328
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 WORCESTER ST
Practice Address - Street 2:SUITE #4
Practice Address - City:NORTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01536-1041
Practice Address - Country:US
Practice Address - Phone:774-551-6317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-19
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty