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1821425257 NPI number — EVOLVE PHYSICAL THERAPY LLC

NPI Number: 1821425257
Health Care Provider/Practitioner: EVOLVE PHYSICAL THERAPY LLC

Information about “1821425257” NPI (EVOLVE PHYSICAL THERAPY LLC) exists in 1821425257 in HTML format HTML  |  1821425257 in plain Text format TXT  |  1821425257 in PDF (Portable Document Format) PDF  |  1821425257 in an XML format XML  formats.

NPI Number : 1821425257 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1821425257",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "EVOLVE PHYSICAL THERAPY LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "16360 ADMEASURE CIR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WOODBRIDGE",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "22191-6374",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "571-426-2704",
    "MailingAddressFaxNumber": "703-763-2809",
    "FirstLinePracticeLocationAddress": "16360 ADMEASURE CIR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WOODBRIDGE",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22191-6374",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "571-426-2704",
    "PracticeLocationAddressFaxNumber": "703-763-2809",
    "EnumerationDate": "09/30/2013",
    "LastUpdateDate": "09/30/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "VERTUDES",
    "AuthorizedOfficialFirstName": "CHRISTIAN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CO-FOUNDER",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PT",
    "AuthorizedOfficialTelephoneNumber": "571-426-2704",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QP2000X",
          "TaxonomyName": "Physical Therapy Clinic/Center",
          "LicenseNumber": "2305207829",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QP2000X",
          "TaxonomyName": "Physical Therapy Clinic/Center",
          "LicenseNumber": "2305204845",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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