Organization
EVOLUTION PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUDREY MEDLOCK (OFFICE MANAGER)
(310) 915-6100
Entity
Organization
Contact information
Practice address
47 HEISSER LN, FARMINGDALE, NY 11735-3314
(516) 665-0882
(516) 665-0884
Mailing address
47 HEISSER LN, FARMINGDALE, NY 11735-3314
(516) 665-0882
(516) 665-0884
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
07/12/2022
Last updated
07/12/2022
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