Provider Demographics
NPI:1003618612
Name:EVANS PT AND PERFORMANCE LLC ZACKERY WRONIUK-EVANS SOLE MBR
Entity type:Organization
Organization Name:EVANS PT AND PERFORMANCE LLC ZACKERY WRONIUK-EVANS SOLE MBR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACKERY
Authorized Official - Middle Name:
Authorized Official - Last Name:WRONIUK-EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:856-776-1039
Mailing Address - Street 1:37 BERKLEY RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT ROYAL
Mailing Address - State:NJ
Mailing Address - Zip Code:08061-1017
Mailing Address - Country:US
Mailing Address - Phone:856-776-1039
Mailing Address - Fax:
Practice Address - Street 1:37 BERKLEY RD
Practice Address - Street 2:
Practice Address - City:MOUNT ROYAL
Practice Address - State:NJ
Practice Address - Zip Code:08061-1017
Practice Address - Country:US
Practice Address - Phone:856-776-1039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy