Provider Demographics
NPI:1902378987
Name:EVOLVE PHYSICAL THERAPY AND SPORTS
Entity Type:Organization
Organization Name:EVOLVE PHYSICAL THERAPY AND SPORTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:225-931-8269
Mailing Address - Street 1:2334 UNIVERSITY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-0441
Mailing Address - Country:US
Mailing Address - Phone:225-931-8269
Mailing Address - Fax:
Practice Address - Street 1:215 STARING LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-4064
Practice Address - Country:US
Practice Address - Phone:225-931-8269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-01
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy