Provider Demographics
NPI:1730653015
Name:EVOLUTION REHAB, LLC
Entity Type:Organization
Organization Name:EVOLUTION REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-891-6911
Mailing Address - Street 1:21839 HIGH PINE TRL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-3049
Mailing Address - Country:US
Mailing Address - Phone:561-891-6911
Mailing Address - Fax:
Practice Address - Street 1:21839 HIGH PINE TRL
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-3049
Practice Address - Country:US
Practice Address - Phone:561-891-6011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-19
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty