Provider Demographics
NPI:1558163147
Name:EVOLVE THERAPY AND PERFORMANCE PLLC
Entity type:Organization
Organization Name:EVOLVE THERAPY AND PERFORMANCE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PAULSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:218-779-6834
Mailing Address - Street 1:401 6TH ST SW
Mailing Address - Street 2:
Mailing Address - City:HANKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58041-4221
Mailing Address - Country:US
Mailing Address - Phone:218-779-6834
Mailing Address - Fax:
Practice Address - Street 1:112 5TH ST SW
Practice Address - Street 2:
Practice Address - City:HANKINSON
Practice Address - State:ND
Practice Address - Zip Code:58041-4417
Practice Address - Country:US
Practice Address - Phone:701-242-7323
Practice Address - Fax:701-242-7797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty