Healthcare Provider Details

I. General information

NPI: 1962319590
Provider Name (Legal Business Name): EVAN TANNER PERALA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E HIGHLAND AVE STE 222
PHOENIX AZ
85016-4876
US

IV. Provider business mailing address

12932 W CRITTENDEN LN
AVONDALE AZ
85392-6683
US

V. Phone/Fax

Practice location:
  • Phone: 480-847-2575
  • Fax:
Mailing address:
  • Phone: 218-282-6014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: