Provider Demographics
NPI:1881307106
Name:EVOLUTION PHYSICAL THERAPY AND PERFORMANCE LLC
Entity type:Organization
Organization Name:EVOLUTION PHYSICAL THERAPY AND PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:S
Authorized Official - Last Name:CABRERA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:845-863-9887
Mailing Address - Street 1:1805 N FLAGLER DR APT 115
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-6535
Mailing Address - Country:US
Mailing Address - Phone:845-863-9887
Mailing Address - Fax:
Practice Address - Street 1:914 PARK AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33403-2404
Practice Address - Country:US
Practice Address - Phone:845-863-9887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy