Provider Demographics
NPI:1538987953
Name:ATHLETIC EVOLUTION STRENGTH AND CONDITIONING, INC
Entity type:Organization
Organization Name:ATHLETIC EVOLUTION STRENGTH AND CONDITIONING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MANAGER AND COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-935-7701
Mailing Address - Street 1:800 W CUMMINGS PARK STE 1400
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-6374
Mailing Address - Country:US
Mailing Address - Phone:781-935-7701
Mailing Address - Fax:
Practice Address - Street 1:800 W CUMMINGS PARK STE 1400
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6374
Practice Address - Country:US
Practice Address - Phone:781-935-7701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty