Provider Demographics
NPI:1659805117
Name:EVOLUTION PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:EVOLUTION PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:914-960-4085
Mailing Address - Street 1:25 OLD KINGS HWY N, STE 13
Mailing Address - Street 2:#255
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4121
Mailing Address - Country:US
Mailing Address - Phone:203-998-6522
Mailing Address - Fax:203-351-3145
Practice Address - Street 1:200 PEMBERWICK RD
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06831-4236
Practice Address - Country:US
Practice Address - Phone:203-813-3659
Practice Address - Fax:475-209-9421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9580261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy