Provider Demographics
NPI:1174601116
Name:EVOLUTION PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:EVOLUTION PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIUNTA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:310-915-6100
Mailing Address - Street 1:322 CULVER BLVD
Mailing Address - Street 2:#217
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7704
Mailing Address - Country:US
Mailing Address - Phone:310-915-6100
Mailing Address - Fax:
Practice Address - Street 1:11825 MAJOR ST
Practice Address - Street 2:PENTHOUSE SUITE
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6356
Practice Address - Country:US
Practice Address - Phone:310-915-6100
Practice Address - Fax:310-915-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34146225100000X
CAPT30287225100000X
CAPT35833225100000X
CAPT28561225100000X
CAPT37632225100000X
CAPT37934225100000X
CA39128225100000X
CAPT26595225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty