Evolution Therapeutics LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

1006876 Issued in OR

Legal business name

EVOLUTION THERAPEUTICS LLC

Practice address

11930 SW Greenburg Rd
Portland, OR 97223-6453

Phone

(503) 956-6686

NPI assigned

Dec 11, 2009

Organization subpart

No

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

Authorized official

Name

Heather Marie Mulcahey, OT

Title

Owner

Phone

(503) 956-6686

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1260489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260489600000",
    "number": "1346579869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11930 SW GREENBURG RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972236453",
            "telephone_number": "503-956-6686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11930 SW GREENBURG RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972236453",
            "telephone_number": "503-956-6686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLUTION THERAPEUTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-11",
        "last_updated": "2009-12-11",
        "status": "A",
        "authorized_official_last_name": "MULCAHEY",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-956-6686",
        "authorized_official_credential": "OT"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OR",
            "license": "1006876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Eves, MA
• Traci E Eveson
• Evgeny I Fedotov
• Evoke Therapy LLC
• Evolution Healthcare, Rehab., & Fitness
• Evolve and Elevate, LLC
• Evolve Wellness
• Evolving Self Integral Counseling, LLC
• Collette Marie Evrard, NP
• Lawrence Raj Ewald

• Clinic/Center in Portland, OR
• Providers in Portland, OR by specialty
• Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2009; 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.