Healthcare Provider Details

I. General information

NPI: 1598366940
Provider Name (Legal Business Name): EVAN PRATT DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11007 RANCH ROAD 2222
AUSTIN TX
78730-1106
US

IV. Provider business mailing address

2519 S LAKELINE BLVD STE 100
CEDAR PARK TX
78613-2964
US

V. Phone/Fax

Practice location:
  • Phone: 512-792-4041
  • Fax:
Mailing address:
  • Phone: 512-331-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1339950
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: