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Organization
EVOLUTION PHYSICAL THERAPY & WELLNESS LLC
Active
Organization
EVOLUTION PHYSICAL THERAPY & WELLNESS LLC
Active
Other names
Evolution Physical Therapy and Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
MIRANDA SMITH (PRACTICE MANAGER)
(530) 205-9538
Entity
Organization
Contact information
Practice address
130 W BERRYHILL DR, GRASS VALLEY, CA 95945-5835
(530) 205-9538
(530) 460-1841
Mailing address
130 W BERRYHILL DR, GRASS VALLEY, CA 95945-5835
(530) 205-9538
(530) 460-1841
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27297
PHYSICAL THERAPY LICENSE
CA
Enumeration date
03/15/2019
Last updated
12/14/2020
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