Athletic Evolution Physical Therapy, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

ATHLETIC EVOLUTION PHYSICAL THERAPY, LLC

Practice address

78C Olympia Ave
Woburn, MA 01801-2057

Phone

(781) 935-7701

NPI assigned

Mar 23, 2018

Organization subpart

No

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

Authorized official

Name

Stefanie Rousselle

Title

Director

Phone

(781) 935-7701

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Locations

Practitioners 7

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

• Jessica Collins Ekberg

  • Occupational Therapist
  • Woburn, MA
  • NPI 1548416936
  Medicare reassignment Care Compare group NPD
• Duane Hersom

  • Physical Therapist
  • Woburn, MA
  • NPI 1518703222
  Medicare reassignment Care Compare group NPD
• Charles Savard

  • Physical Therapist
  • Wilmington, MA
  • NPI 1811769011
  Medicare reassignment Care Compare group NPD
• Shannon Michael Walton, MSPT

  • Physical Therapist
  • Woburn, MA
  • NPI 1932216553
  Medicare reassignment Care Compare group NPD
• Nathan Clarke

  • Physical Therapist
  • Wilmington, MA
  • NPI 1043920218
  Medicare reassignment Care Compare group
• Stefanie Depaul, PT, DPT, CSCS, RYT

  • Physical Therapist
  • Stoneham, MA
  • NPI 1104181650
  Medicare reassignment NPD
• Jarod Esnoz, PT, DPT

  • Physical Therapist
  • Brookline, MA
  • NPI 1912730482
  Medicare reassignment NPD

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

{
    "created_epoch": "1521763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521763200000",
    "number": "1346744216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "78C OLYMPIA AVE",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018012057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "78C OLYMPIA AVE",
            "city": "WOBURN",
            "state": "MA",
            "postal_code": "018012057",
            "telephone_number": "781-935-7701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATHLETIC EVOLUTION PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-23",
        "last_updated": "2018-03-23",
        "status": "A",
        "authorized_official_last_name": "ROUSSELLE",
        "authorized_official_first_name": "STEFANIE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "781-935-7701"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Arthur
• Nithu Priyam Arunagiri
• Ashley Holmes, LLC
• Athena Dental Group PLLC
• Athletic Edge Physical Therapy
• Athletic Evolution Strength and Conditioning, Inc
• Atlas Home Health Care LLC
• Atoz Psychotherapy Services, LLC
• Julie Attardo, PT
• Kerry Ann Atwood

• Physical Therapy Clinic/Center in Woburn, MA
• Providers in Woburn, MA by specialty
• Physical Therapy Clinic/Center in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.