Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT871083 | DC |
NPI | 1144608019 |
---|---|
Provider Name | Mrs. Bernardine Evans |
First Address | Washington, DC 20012-1135 |
Second Address | Plymouth Meeting, PA 19462-2225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2015 |
Last Update Date | 12/05/2015 |