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General NPI Number Information
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NPI Number | 1619846607
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Entity Type | Organization
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Legal Business Name | EVO TN HENDERSONVILLE LLP
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Dates
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Enumeration Date | 10/30/2025
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 225 MOLLY WALTON DR STE A
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-2199
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Country | US
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Telephone | 615-266-5599
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Fax |
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Provider Business Mailing Address
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Address Line | 225 MOLLY WALTON DR STE A
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-2199
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Country | US
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Telephone | 615-266-5599
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Fax |
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Authorized Official
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Title or Position | OWNER / CEO / GENERAL PARTNER
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Name | DR. BENJAMIN MOORE
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Credential | PT, DPT
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Telephone | 601-668-6775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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