Healthcare Provider Details

I. General information

NPI: 1174601116
Provider Name (Legal Business Name): EVOLUTION PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11825 MAJOR ST PENTHOUSE SUITE
CULVER CITY CA
90230-6356
US

IV. Provider business mailing address

322 CULVER BLVD #217
PLAYA DEL REY CA
90293-7704
US

V. Phone/Fax

Practice location:
  • Phone: 310-915-6100
  • Fax: 310-915-0100
Mailing address:
  • Phone: 310-915-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT34146
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT30287
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT35833
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT28561
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT37632
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT37934
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number39128
License Number StateCA
# 8
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT26595
License Number StateCA

VIII. Authorized Official

Name: MICHAEL GIUNTA
Title or Position: OWNER/CEO
Credential: DPT
Phone: 310-915-6100