Healthcare Provider Details

I. General information

NPI: 1023840246
Provider Name (Legal Business Name): EVOLUTION REHAB GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 BUSH RD
JUPITER FL
33458-5694
US

IV. Provider business mailing address

7950 DANI DR # 140-2
FORT MYERS FL
33966-8012
US

V. Phone/Fax

Practice location:
  • Phone: 561-900-2423
  • Fax: 561-600-3011
Mailing address:
  • Phone: 561-900-2423
  • Fax: 561-600-3011

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
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIN MARC GALIN
Title or Position: ADMINISTRATOR
Credential: DPT
Phone: 561-900-2423