Provider Demographics
NPI:1871125799
Name:EVOLUTION REHAB GROUP LLC
Entity type:Organization
Organization Name:EVOLUTION REHAB GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GALIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:561-900-2423
Mailing Address - Street 1:8135 EMERALD WINDS CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-7837
Mailing Address - Country:US
Mailing Address - Phone:561-685-4444
Mailing Address - Fax:
Practice Address - Street 1:4705 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-5135
Practice Address - Country:US
Practice Address - Phone:561-900-2423
Practice Address - Fax:561-600-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-08
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation