Healthcare Provider Details

I. General information

NPI: 1306255005
Provider Name (Legal Business Name): KARA EVENS PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17300 NORTH OUTER 40 RD SUITE 202
CHESTERFIELD MO
63005-1375
US

IV. Provider business mailing address

12360 MANCHESTER RD SUITE 150
SAINT LOUIS MO
63131-4312
US

V. Phone/Fax

Practice location:
  • Phone: 636-728-1777
  • Fax: 636-728-1793
Mailing address:
  • Phone: 314-966-2273
  • Fax: 314-966-8855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number2014026933
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: