Provider Demographics
NPI:1972281350
Name:EVOLVE THERAPY SERVICES LLC
Entity type:Organization
Organization Name:EVOLVE THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILADY
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZQUEZ DE JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-974-7513
Mailing Address - Street 1:PO BOX 7303
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 CALLE DUFRENSE
Practice Address - Street 2:ESQUINA MANUEL CRUZ
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:939-328-7297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1020-2OtherJUNTA EXAMINADORA DE TERAPIA OCUPACIONAL