Evolve Occupational & Physical Therapy P.C.

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

EVOLVE OCCUPATIONAL & PHYSICAL THERAPY P.C.

Practice address

11490 Braddock Dr
Culver City, CA 90230-5151

Phone

(856) 220-1460

Fax

(855) 330-1292

NPI assigned

Jul 2, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Lori Kenuk, PT, DPT

Title

Ceo, President

Phone

(856) 220-1460

Specialties & licenses 1

Addresses

Other names 1

• Evolve Therapy Other name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert Russow, MA, OTR/L

  • Occupational Therapist
  • Culver City, CA
  • NPI 1790164507
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1404259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1404259200000",
    "number": "1043626724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11490 BRADDOCK DR",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902305151",
            "telephone_number": "856-220-1460",
            "fax_number": "855-330-1292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11490 BRADDOCK DR",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902305151",
            "telephone_number": "856-220-1460",
            "fax_number": "855-330-1292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLVE OCCUPATIONAL & PHYSICAL THERAPY P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-02",
        "last_updated": "2014-07-02",
        "status": "A",
        "authorized_official_last_name": "KENUK",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "CEO, PRESIDENT",
        "authorized_official_telephone_number": "856-220-1460",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evolve Therapy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Ethos Recovery, LLC
• Alexanderia Dayona Eubank
• Rita Evazyan
• Shawn Chantal Evelyn, PMHNP
• Evolution Physical Therapy, Inc
• Evolve Surgery Center, LLC
• Dennis Ewing
• Exceptional Children Foundation
• Exceptional Children's Foundation
• Exceptional Children's Foundation

• Physical Therapy Clinic/Center in Culver City, CA
• Providers in Culver City, CA by specialty
• Physical Therapy Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.