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General NPI Number Information
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NPI Number | 1093931461
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Entity Type | Individual
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Provider Name | CHRISTIAN C EVANS P.T.
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Gender | Male
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 555 31ST ST
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-1235
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Country | US
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Telephone | 630-515-7249
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Fax | 630-515-7224
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Provider Business Mailing Address
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Address Line | 21W742 GLEN VALLEY DR
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City | GLEN ELLYN
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State | IL
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Zip | 60137-7041
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Country | US
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Telephone | 630-534-6160
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Fax | 630-515-7224
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | IL
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