# KICK PERFORMANCE THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235881178
- **Authorized official:** MR. NATHAN EVANS (PHYSICAL THERAPIST)
- **Authorized official phone:** (806) 670-3481

## Contact information

- **Practice address:** EVOLUTION HEALTHCARE AND FITNESS, 905 SE ANKENY ST, PORTLAND, OR 97214
- **Practice address phone:** (971) 236-7610
- **Mailing address:** 949 NW OVERTON ST UNIT 1508, PORTLAND, OR 97209-3278
- **Mailing address phone:** (806) 670-3481

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 01/21/2022
- **Last updated:** 08/05/2025