Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 40QA01668500 | NJ |
NPI | 1003265919 |
---|---|
Provider Name | Andrew Michael Evans |
First Address | Harrisburg, PA 17111-3576 |
Second Address | Sparta, NJ 07871-1941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2016 |
Last Update Date | 10/06/2016 |