Provider Demographics
NPI:1285982835
Name:R-EVOLVE PHYSICAL THERAPY P.C.
Entity type:Organization
Organization Name:R-EVOLVE PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:LEMYRE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:518-669-1856
Mailing Address - Street 1:125 LAKE ST
Mailing Address - Street 2:APT 8GN
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2419
Mailing Address - Country:US
Mailing Address - Phone:518-669-1856
Mailing Address - Fax:
Practice Address - Street 1:125 LAKE ST
Practice Address - Street 2:APT 8GN
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-2419
Practice Address - Country:US
Practice Address - Phone:518-669-1856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031217261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1174757389OtherNATIONAL PROVIDER IDENTIFIER
NY031217OtherNYS LICENSE NUMBER