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General NPI Number Information
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NPI Number | 1497222749
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Entity Type | Organization
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Legal Business Name | EVOLVE PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 10/25/2018
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Last Update Date | 10/25/2018
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Provider Practice Location Address
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Address Line | 6 BARN DR
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City | CUMBERLAND
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State | RI
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Zip | 02864-4106
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Country | US
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Telephone | 401-580-2976
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Fax |
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Provider Business Mailing Address
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Address Line | 6 BARN DR
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City | CUMBERLAND
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State | RI
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Zip | 02864-4106
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Country | US
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Telephone | 401-580-2976
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLEY A. CHULA-MAGUIRE
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Credential | DPT
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Telephone | 401-580-2976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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