Provider Demographics
NPI:1821425257
Name:EVOLVE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:EVOLVE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VERTUDES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:571-426-2704
Mailing Address - Street 1:16360 ADMEASURE CIR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-6374
Mailing Address - Country:US
Mailing Address - Phone:571-426-2704
Mailing Address - Fax:703-763-2809
Practice Address - Street 1:16360 ADMEASURE CIR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-6374
Practice Address - Country:US
Practice Address - Phone:571-426-2704
Practice Address - Fax:703-763-2809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204845261QP2000X
VA2305207829261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy