Provider Demographics
NPI:1790822807
Name:EVOLUTION PHYSICAL THERAPY AND YOGA STUDIO INC.
Entity Type:Organization
Organization Name:EVOLUTION PHYSICAL THERAPY AND YOGA STUDIO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:CARSCADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:802-864-9642
Mailing Address - Street 1:20 KILBURN ST
Mailing Address - Street 2:SUITE#120
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-4720
Mailing Address - Country:US
Mailing Address - Phone:802-864-9642
Mailing Address - Fax:802-864-9643
Practice Address - Street 1:20 KILBURN ST
Practice Address - Street 2:SUITE #120
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4720
Practice Address - Country:US
Practice Address - Phone:802-864-9642
Practice Address - Fax:802-864-9643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty