MEDICARE: ARIEL EVANS

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	PT39975	FL

General Provider Information

NPI Number	:	1881394542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIEL EVANS

Provider Business Mailing Address
First Line	:	105 S FLORIDA AVE STE 3
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-4619
Country	:	US
Telephone Number	:	863-225-2317
Fax Number	:	877-596-1938

Provider Business Practice Location Address
First Line	:	105 S FLORIDA AVE STE 3
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-4619
Country	:	US
Telephone Number	:	863-225-2317
Fax Number	:	877-596-1938

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

Provider Enumeration Date	:	03/09/2023
Last Update Date	:	05/28/2026

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Directions to “ ARIEL EVANS ” Practice Location

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