Provider Demographics
NPI:1639780489
Name:EVOLVE PHYSICAL THERAPY, PLC
Entity Type:Organization
Organization Name:EVOLVE PHYSICAL THERAPY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOTTLIEB
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:856-220-1460
Mailing Address - Street 1:PO BOX 381
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-0381
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:192 ALLAN RIDGE RD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:VT
Practice Address - Zip Code:05661-8680
Practice Address - Country:US
Practice Address - Phone:856-220-1460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty