Provider Demographics
NPI:1528404324
Name:STRATOS GROUP LLC
Entity Type:Organization
Organization Name:STRATOS GROUP LLC
Other - Org Name:EVOLVE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:541-550-7291
Mailing Address - Street 1:20510 SW ROY ROGERS RD STE 120
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9320
Mailing Address - Country:US
Mailing Address - Phone:541-550-7291
Mailing Address - Fax:541-550-7356
Practice Address - Street 1:20510 SW ROY ROGERS RD STE 120
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9320
Practice Address - Country:US
Practice Address - Phone:541-550-7291
Practice Address - Fax:541-550-7356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR61612OtherPT LICENSE