Healthcare Provider Details

I. General information

NPI: 1730653015
Provider Name (Legal Business Name): EVOLUTION REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2019
Last Update Date: 07/03/2020
Certification Date: 07/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21839 HIGH PINE TRL
BOCA RATON FL
33428-3049
US

IV. Provider business mailing address

21839 HIGH PINE TRL
BOCA RATON FL
33428-3049
US

V. Phone/Fax

Practice location:
  • Phone: 561-891-6011
  • Fax:
Mailing address:
  • Phone: 561-891-6911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: TATIANA PES
Title or Position: MEMBER
Credential: PT
Phone: 561-891-6911