NPIMap

Organization Active NPI

Evolve Therapy and Wellness PLLC

Doing business as Evolve Therapy and Wellness

  • Physical Therapist
  • Pensacola, FL
National Provider Identifier
1932815644
Registry record updated Apr 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
EVOLVE THERAPY AND WELLNESS PLLC
Doing business as
Evolve Therapy and Wellness
Practice address
209 S a St
Pensacola, FL 32502-5554
Phone
(850) 533-0266
Fax
(850) 807-5446
NPI assigned
Jan 25, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2023

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

Authorized official

Name
Sourachack S Sananikone, DPTNPI 1013225002
Title
Owner
Phone
(850) 418-0014

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

209 S a St
Pensacola, FL 32502-5554

Mailing address

2786 Inverness Park Dr
Gulf Breeze, FL 32563-3049
Phone (850) 418-0014

Other names 1

  • Evolve Therapy and Wellness Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230321000890 FL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6608240312 Receives reassigned benefits from 1 practitioner
Practice locations: Pensacola, FL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1674604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680652800000",
    "number": "1932815644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2786 INVERNESS PARK DR",
            "city": "GULF BREEZE",
            "state": "FL",
            "postal_code": "325633049",
            "telephone_number": "850-418-0014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 S A ST",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325025554",
            "telephone_number": "850-533-0266",
            "fax_number": "850-807-5446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLVE THERAPY AND WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-25",
        "last_updated": "2023-04-05",
        "certification_date": "2023-04-05",
        "status": "A",
        "authorized_official_last_name": "SANANIKONE",
        "authorized_official_first_name": "SOURACHACK",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-418-0014",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evolve Therapy and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pensacola, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2023; 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.