Healthcare Provider Details

I. General information

NPI: 1356057483
Provider Name (Legal Business Name): EVELYN SMITTENAAR PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7556 TEAGUE RD STE 240
HANOVER MD
21076-1389
US

IV. Provider business mailing address

7556 TEAGUE RD STE 240
HANOVER MD
21076-1389
US

V. Phone/Fax

Practice location:
  • Phone: 410-768-5555
  • Fax:
Mailing address:
  • Phone: 410-768-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA5775
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: