Healthcare Provider Details

I. General information

NPI: 1063676971
Provider Name (Legal Business Name): NANCY KLEMIC EVANS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY KLEMIC PT

II. Dates (important events)

Enumeration Date: 07/10/2008
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 BAKER CIRCLE
ADAMSTOWN MD
21710
US

IV. Provider business mailing address

3200 BAKER CIRCLE
ADAMSTOWN MD
21710
US

V. Phone/Fax

Practice location:
  • Phone: 301-644-1646
  • Fax: 301-644-1693
Mailing address:
  • Phone: 301-644-1646
  • Fax: 301-644-1693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14509
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number14509
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: