Healthcare Provider Details

I. General information

NPI: 1063432748
Provider Name (Legal Business Name): BRIAN EVANS P.T., D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 MONARCHOS DR
HAVRE DE GRACE MD
21078-4010
US

IV. Provider business mailing address

750 MONARCHOS DR
HAVRE DE GRACE MD
21078-4010
US

V. Phone/Fax

Practice location:
  • Phone: 443-604-1762
  • Fax:
Mailing address:
  • Phone: 443-604-1762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21545
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: