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General NPI Number Information
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NPI Number | 1821425257
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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 | 09/30/2013
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Last Update Date | 09/30/2013
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Provider Practice Location Address
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Address Line | 16360 ADMEASURE CIR
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City | WOODBRIDGE
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State | VA
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Zip | 22191-6374
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Country | US
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Telephone | 571-426-2704
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Fax | 703-763-2809
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Provider Business Mailing Address
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Address Line | 16360 ADMEASURE CIR
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City | WOODBRIDGE
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State | VA
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Zip | 22191-6374
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Country | US
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Telephone | 571-426-2704
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Fax | 703-763-2809
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Authorized Official
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Title or Position | CO-FOUNDER
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Name | MR. CHRISTIAN VERTUDES
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Credential | PT
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Telephone | 571-426-2704
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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 | 2305207829
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 2305204845
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License Number State | VA
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