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General NPI Number Information
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NPI Number | 1932543014
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Entity Type | Organization
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Legal Business Name | EVOLUTION PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 04/19/2013
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Last Update Date | 04/19/2013
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Provider Practice Location Address
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Address Line | 9312 E RAINTREE DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-2094
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Country | US
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Telephone | 480-767-2769
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Fax | 480-767-2745
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Provider Business Mailing Address
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Address Line | 9312 E RAINTREE DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-2094
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Country | US
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Telephone | 480-767-2769
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Fax | 480-767-2745
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | JEFFREY BERAN
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Credential | PT, DPT, ATC
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Telephone | 480-767-2769
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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 | 7398
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License Number State | AZ
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