Healthcare Provider Details

I. General information

NPI: 1104743848
Provider Name (Legal Business Name): EVAN CARVALHEIRA PT, DPT, MS, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

873 EL CAMINO REAL
MENLO PARK CA
94025-4807
US

IV. Provider business mailing address

28 RIESLING WAY
SCOTTS VALLEY CA
95066-3255
US

V. Phone/Fax

Practice location:
  • Phone: 650-419-7564
  • Fax:
Mailing address:
  • Phone: 831-345-7105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number310364
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: