Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 62510 | OR |
NPI | 1548749823 |
---|---|
Provider Name | Nathan Evans |
First Address | Portland, OR 97209-2516 |
Second Address | Portland, OR 97201-5801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2018 |
Last Update Date | 14/11/2021 |