Healthcare Provider Details

I. General information

NPI: 1649962549
Provider Name (Legal Business Name): AMITY RAE ARELLANO EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 05/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 VIKING DR STE 430
VIRGINIA BEACH VA
23452-7349
US

IV. Provider business mailing address

4456 SANIBEL CIR STE 404
VIRGINIA BEACH VA
23462-4694
US

V. Phone/Fax

Practice location:
  • Phone: 757-514-1915
  • Fax:
Mailing address:
  • Phone: 757-943-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306605153
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: