Healthcare Provider Details

I. General information

NPI: 1003265919
Provider Name (Legal Business Name): ANDREW MICHAEL EVANS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13A MAIN ST SUITE 4
SPARTA NJ
07871-1941
US

IV. Provider business mailing address

5300 DERRY ST 2ND FLOOR
HARRISBURG PA
17111-3576
US

V. Phone/Fax

Practice location:
  • Phone: 973-726-7400
  • Fax: 973-726-7440
Mailing address:
  • Phone: 717-839-2110
  • Fax: 717-565-1934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01668500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: