MEDICARE: EVOLVE PHYSICAL THERAPY AND SPORTS MEDICINE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1043924319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLVE PHYSICAL THERAPY AND SPORTS MEDICINE LLC

Provider Business Mailing Address
First Line	:	2691 N LAKE DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-3838
Country	:	US
Telephone Number	:	414-840-9409
Fax Number	:

Provider Business Practice Location Address
First Line	:	2691 N LAKE DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-3838
Country	:	US
Telephone Number	:	414-840-9409
Fax Number	:

Authorized Official
Title or Position	:	CLINIC OWNER
Name	:	MR. WILL BRUCKER
Credential	:	DPT
Telephone Number	:	309-287-2526

Provider Enumeration Date	:	01/10/2023
Last Update Date	:	01/10/2023

Similar Medicare Providers

1336296722 — K. KWANG SOO, M.D., S.C.
Practice Location Address:

2691 N LAKE DR
MILWAUKEE, WI
53211-3838

Practice Phone: 414-228-8300
Practice Fax: 414-228-6303

1316483076 — YONGJIE MA
Practice Location Address:

3838 N OAKLAND AVE , APT 274
MILWAUKEE, WI
53211-2258

Practice Phone: 414-306-1961
Practice Fax:

1902809494 — MEDICAL EQUIPMENT SPECIALISTS LLC
Practice Location Address:

3838 S 35TH ST
MILWAUKEE, WI
53221-1067

Practice Phone: 414-282-5451
Practice Fax: 414-282-5467

1013922905 — WALGREEN CO
Practice Location Address:

3701 S HOWELL AVE
MILWAUKEE, WI
53207-3838

Practice Phone: 414-482-1470
Practice Fax:

1598048696 — LONG XUAN HUA PHARMD
Practice Location Address:

3701 S HOWELL AVE
MILWAUKEE, WI
53207-3838

Practice Phone: 414-482-1470
Practice Fax: 414-482-9658

1861776536 — KELLY CASTALDO PHARM. D.
Practice Location Address:

3701 S HOWELL AVE
MILWAUKEE, WI
53207-3838

Practice Phone: 414-482-1470
Practice Fax: 414-482-9658

Directions to “EVOLVE PHYSICAL THERAPY AND SPORTS MEDICINE LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.