Healthcare Provider Details

I. General information

NPI: 1801265426
Provider Name (Legal Business Name): WILLIAM EVANS PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7802 SUMMER BREEZE TRL
HOWELL MI
48843-9589
US

IV. Provider business mailing address

PO BOX 161
MILFORD MI
48381-0161
US

V. Phone/Fax

Practice location:
  • Phone: 248-798-8451
  • Fax:
Mailing address:
  • Phone: 248-798-8451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5501010010
License Number StateMI

VIII. Authorized Official

Name: WILLIAM EVANS
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: PT
Phone: 248-798-8451