Healthcare Provider Details

I. General information

NPI: 1407763881
Provider Name (Legal Business Name): AMANDA LEIGH EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANDY EVANS PTA

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 S 900 E STE 100
MURRAY UT
84117-6658
US

IV. Provider business mailing address

1419 W 3175 N
LEHI UT
84043-5268
US

V. Phone/Fax

Practice location:
  • Phone: 801-261-3321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number14292978-2402
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: