=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740860857
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVOLVE PHYSICAL THERAPY OF ROCHESTER PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2021
-----------------------------------------------------
Last Update Date | 03/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 141 SULLYS TRL STE 3
-----------------------------------------------------
City | PITTSFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14534-4563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-997-2661
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 141 SULLYS TRL STE 3
-----------------------------------------------------
City | PITTSFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14534-4563
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-203-1320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST/CO-OWNER
-----------------------------------------------------
Name | MRS. JENNIFER MORIN
-----------------------------------------------------
Credential | MSPT, OCS
-----------------------------------------------------
Telephone | 585-203-1320
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------