Healthcare Provider Details

I. General information

NPI: 1003723610
Provider Name (Legal Business Name): EVERGREEN THERAPY VA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 COLLEGE PARK BLVD
VIRGINIA BEACH VA
23464-4468
US

IV. Provider business mailing address

1135 E VETERANS HWY STE 101
JACKSON NJ
08527-5092
US

V. Phone/Fax

Practice location:
  • Phone: 732-402-3600
  • Fax:
Mailing address:
  • Phone: 732-402-3600
  • 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
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: AHARON STERN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 732-402-3600