Healthcare Provider Details

I. General information

NPI: 1912149568
Provider Name (Legal Business Name): SHIRLEE EVANS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2009
Last Update Date: 03/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 SW RESERVOIR RD
REDMOND OR
97756-9481
US

IV. Provider business mailing address

3025 SW RESERVOIR RD
REDMOND OR
97756-9481
US

V. Phone/Fax

Practice location:
  • Phone: 541-548-5066
  • Fax:
Mailing address:
  • Phone: 541-548-5066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2643
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: