Provider Demographics
NPI:1497517569
Name:EVOLUTIONARY MOTION PHYSICAL THERAPY AND WELLNESS, INC.
Entity Type:Organization
Organization Name:EVOLUTIONARY MOTION PHYSICAL THERAPY AND WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEREZOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:310-259-9577
Mailing Address - Street 1:149 S CLARK DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2603
Mailing Address - Country:US
Mailing Address - Phone:310-259-9577
Mailing Address - Fax:
Practice Address - Street 1:149 S CLARK DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2603
Practice Address - Country:US
Practice Address - Phone:310-259-9577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty