Evolution Physical Therapy

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

EVOLUTION PHYSICAL THERAPY

Practice address

47 Heisser LN
Farmingdale, NY 11735-3314

Phone

(516) 665-0882

Fax

(516) 665-0884

NPI assigned

Jul 12, 2022

Organization subpart

No

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

Authorized official

Name

Audrey Medlock

Title

Office Manager

Phone

(310) 915-6100

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1657584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657584000000",
    "number": "1649904079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 HEISSER LN",
            "city": "FARMINGDALE",
            "state": "NY",
            "postal_code": "117353314",
            "telephone_number": "516-665-0882",
            "fax_number": "516-665-0884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 HEISSER LN",
            "city": "FARMINGDALE",
            "state": "NY",
            "postal_code": "117353314",
            "telephone_number": "516-665-0882",
            "fax_number": "516-665-0884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLUTION PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-12",
        "last_updated": "2022-07-12",
        "certification_date": "2022-07-12",
        "status": "A",
        "authorized_official_last_name": "MEDLOCK",
        "authorized_official_first_name": "AUDREY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "310-915-6100"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mena S Essak
• Ania Lisa Etienne
• Kristen Etzel, PHARMD
• Euni Suk, MD PC
• Karen Eustaquio, RN IBCLC
• Evolution Physical Therapy Ny PLLC
• Exact Medical Services PLLC
• Eyeglass Depot Optical
• Franklin Ezeorah
• Paulet Facey

• Physical Therapy Clinic/Center in Farmingdale, NY
• Providers in Farmingdale, NY by specialty
• Physical Therapy Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2022; 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.