Provider Demographics
NPI:1497222749
Name:EVOLVE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:EVOLVE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHULA-MAGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:401-580-2976
Mailing Address - Street 1:6 BARN DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-4106
Mailing Address - Country:US
Mailing Address - Phone:401-580-2976
Mailing Address - Fax:
Practice Address - Street 1:6 BARN DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-4106
Practice Address - Country:US
Practice Address - Phone:401-580-2976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy