Healthcare Provider Details

I. General information

NPI: 1790822807
Provider Name (Legal Business Name): EVOLUTION PHYSICAL THERAPY AND YOGA STUDIO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 KILBURN ST SUITE #120
BURLINGTON VT
05401-4720
US

IV. Provider business mailing address

20 KILBURN ST SUITE#120
BURLINGTON VT
05401-4720
US

V. Phone/Fax

Practice location:
  • Phone: 802-864-9642
  • Fax: 802-864-9643
Mailing address:
  • Phone: 802-864-9642
  • Fax: 802-864-9643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. JANET L. CARSCADDEN
Title or Position: OWNER
Credential: PT, DPT
Phone: 802-864-9642