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General NPI Number Information
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NPI Number | 1114683117
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Entity Type | Individual
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Provider Name | EVANN SLAUGHTER PT, DPT, CSCS
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Gender | Female
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Dates
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Enumeration Date | 11/14/2021
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Last Update Date | 11/14/2021
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Provider Practice Location Address
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Address Line | 8885 CENTRE PARK DR
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City | COLUMBIA
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State | MD
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Zip | 21045-2199
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Country | US
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Telephone | 410-730-1275
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Fax |
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Provider Business Mailing Address
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Address Line | 4870 DORSEY HALL DR UNIT 5
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-7716
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Country | US
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Telephone | 301-861-9237
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Fax |
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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 | 28730
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License Number State | MD
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