MEDICARE: EVOLVE HEALTHCARE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	225100000X	Physical Therapist
2	235Z00000X	Speech-Language Pathologist
3	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1316588841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLVE HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	4535 N MARMORA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3138
Country	:	US
Telephone Number	:	312-278-7138
Fax Number	:	708-776-7816

Provider Business Practice Location Address
First Line	:	4535 N MARMORA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60630-3138
Country	:	US
Telephone Number	:	312-278-7138
Fax Number	:	708-776-7816

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JESUS JOEL MANAGUELOD
Credential	:	OTR/L
Telephone Number	:	312-278-7138

Provider Enumeration Date	:	10/07/2019
Last Update Date	:	10/07/2019

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Directions to “EVOLVE HEALTHCARE, LLC ” Practice Location

Language	Start Address	Practice Location

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