Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 1281912 | TX |
NPI | 1033666912 |
---|---|
Provider Name | Evan Varana |
First Address | West Lake Hills, TX 78746-5266 |
Second Address | West Lake Hills, TX 78746-5266 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2016 |
Last Update Date | 08/09/2016 |