Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant |
NPI | 1013110402 |
---|---|
Provider Name | Mrs. Tina Michelle Evans |
First Address | Naperville, IL 60563-3286 |
Second Address | Naperville, IL 60563-3286 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 31/03/2015 |