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General NPI Number Information
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NPI Number | 1619856929
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Entity Type | Organization
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Legal Business Name | EVOLVE NEURO THERAPY LLC
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Dates
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Enumeration Date | 08/29/2025
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 111 E MONUMENT AVE UNIT 410
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City | KISSIMMEE
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State | FL
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Zip | 34741-5774
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Country | US
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Telephone | 407-904-5285
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Fax |
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Provider Business Mailing Address
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Address Line | 111 E MONUMENT AVE UNIT 410
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City | KISSIMMEE
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State | FL
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Zip | 34741-5774
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Country | US
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Telephone | 407-904-5285
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAZMIN PERALTA
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Credential | OTR/L
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Telephone | 407-460-8500
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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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Taxonomy #2
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Taxonomy Code | 2251N0400X
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Taxonomy Name | Neurology Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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