Provider Demographics
NPI:1831562362
Name:EVOKE PHYSICAL THERAPY AND WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:EVOKE PHYSICAL THERAPY AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:LABELLA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:303-475-6252
Mailing Address - Street 1:201 DAVIS GROVE CIRCLE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519
Mailing Address - Country:US
Mailing Address - Phone:303-475-6252
Mailing Address - Fax:844-913-1900
Practice Address - Street 1:201 DAVIS GROVE CIRCLE
Practice Address - Street 2:SUITE 106
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519
Practice Address - Country:US
Practice Address - Phone:303-475-6252
Practice Address - Fax:303-791-2531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0012994261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy