Provider Demographics
NPI:1861978512
Name:EVOLVE PHYSICAL THERAPY AND PERFORMANCE, INC
Entity type:Organization
Organization Name:EVOLVE PHYSICAL THERAPY AND PERFORMANCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, SCS, COMT, CSCS
Authorized Official - Phone:608-239-4249
Mailing Address - Street 1:2604 E GRANADA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-4612
Mailing Address - Country:US
Mailing Address - Phone:608-239-4249
Mailing Address - Fax:
Practice Address - Street 1:340 CLOVIS AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-1116
Practice Address - Country:US
Practice Address - Phone:608-239-4249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT2925682251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty