MEDICARE: MR. BARRY A EVANS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2770	OK

General Provider Information

NPI Number	:	1073732228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BARRY A EVANS PT

Provider Business Mailing Address
First Line	:	8112 E MADISON ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74014-7440
Country	:	US
Telephone Number	:	918-357-2497
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 NW EXPRESSWAY ST
Second Line	:	SUITE 809
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-5474
Country	:	US
Telephone Number	:	866-848-8813
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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