Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 14509 | MD |
N | 2251G0304X | Physical Therapist - Geriatrics | 14509 | MD |
NPI | 1063676971 |
---|---|
Provider Name | Mrs. Nancy Klemic Evans |
First Address | Adamstown, MD 21710 |
Second Address | Adamstown, MD 21710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2008 |
Last Update Date | 10/07/2008 |