MEDICARE: EVOLVE PERFORMANCE PT, PLLC

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1740032564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVOLVE PERFORMANCE PT, PLLC

Provider Business Mailing Address
First Line	:	4105 31ST AVE
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11103-3462
Country	:	US
Telephone Number	:	929-483-8571
Fax Number	:

Provider Business Practice Location Address
First Line	:	4105 31ST AVE
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11103-3462
Country	:	US
Telephone Number	:	516-639-4320
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JARED EINHORN
Credential	:	PT, DPT
Telephone Number	:	516-639-4320

Provider Enumeration Date	:	04/04/2024
Last Update Date	:	03/10/2026

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