Healthcare Provider Details

I. General information

NPI: 1699986406
Provider Name (Legal Business Name): JOHN MICHAEL EVANS LPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E ALTON GLOOR BLVD
BROWNSVILLE TX
78526-3328
US

IV. Provider business mailing address

33993 E SAN FERNANDO RD
RIO HONDO TX
78583
US

V. Phone/Fax

Practice location:
  • Phone: 956-350-7329
  • Fax: 956-350-7330
Mailing address:
  • Phone: 956-350-7329
  • Fax: 956-350-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2020921
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: