MEDICARE: MEGAN MARIE 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	10811	NC
2	225100000X	Physical Therapist	5501014903	MI
3	225100000X	Physical Therapist	6812	SC

General Provider Information

NPI Number	:	1326132317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN MARIE EVANS PT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	630-296-2223
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 MEDICAL PKWY
Second Line	:	STE 150
City	:	GREER
State	:	SC
Zip	:	29650-2456
Country	:	US
Telephone Number	:	864-797-9600
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	11/06/2015

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Directions to “ MEGAN MARIE EVANS PT” Practice Location

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