Healthcare Provider Details

I. General information

NPI: 1891083606
Provider Name (Legal Business Name): DANIAL PAUL EVANS MLS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W HWY 50
SALIDA CO
81201-2238
US

IV. Provider business mailing address

PO BOX 595
PONCHA SPRINGS CO
81242-0595
US

V. Phone/Fax

Practice location:
  • Phone: 719-530-2040
  • Fax:
Mailing address:
  • Phone: 785-650-7194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number974
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: