Healthcare Provider Details

I. General information

NPI: 1952634479
Provider Name (Legal Business Name): AMY D EVANS MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 N JEFFERSON ST
JACKSONVILLE FL
32209-6810
US

IV. Provider business mailing address

322 PABLO RD
PONTE VEDRA BEACH FL
32082-1806
US

V. Phone/Fax

Practice location:
  • Phone: 904-360-7022
  • Fax:
Mailing address:
  • Phone: 904-280-1694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT26258
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT26258
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: