Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 05005040A | IN |
NPI | 1104089150 |
---|---|
Provider Name | Ms. Evan Ann Cross |
First Address | Indianapolis, IN 46228-1454 |
Second Address | Indianapolis, IN 46228-1454 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2008 |
Last Update Date | 06/05/2015 |