Provider Demographics
NPI:1720827082
Name:EVOLVE ATHLETE RECOVERY INC
Entity type:Organization
Organization Name:EVOLVE ATHLETE RECOVERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LEAD THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CORRINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:734-717-1332
Mailing Address - Street 1:39325 PLYMOUTH RD STE 205
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-4531
Mailing Address - Country:US
Mailing Address - Phone:734-717-1332
Mailing Address - Fax:
Practice Address - Street 1:39325 PLYMOUTH RD STE 205
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-4531
Practice Address - Country:US
Practice Address - Phone:734-717-1332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty