Provider Demographics
NPI:1619846607
Name:EVO TN HENDERSONVILLE LLP
Entity type:Organization
Organization Name:EVO TN HENDERSONVILLE LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CEO / GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:601-668-6775
Mailing Address - Street 1:225 MOLLY WALTON DR STE A
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2199
Mailing Address - Country:US
Mailing Address - Phone:615-266-5599
Mailing Address - Fax:
Practice Address - Street 1:225 MOLLY WALTON DR STE A
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2199
Practice Address - Country:US
Practice Address - Phone:615-266-5599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty