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1386465169 NPI number — EVANS PHYSICAL THERAPY & SPORT PERFORMANCE, LLC

NPI Number: 1386465169
Health Care Provider/Practitioner: EVANS PHYSICAL THERAPY & SPORT PERFORMANCE, LLC

Information about “1386465169” NPI (EVANS PHYSICAL THERAPY & SPORT PERFORMANCE, LLC) exists in 1386465169 in HTML format HTML  |  1386465169 in plain Text format TXT  |  1386465169 in PDF (Portable Document Format) PDF  |  1386465169 in an XML format XML  formats.

NPI Number : 1386465169 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1386465169",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "EVANS PHYSICAL THERAPY & SPORT PERFORMANCE, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4231 SPADEFOOT CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LANCASTER",
    "MailingAddressStateName": "SC",
    "MailingAddressPostalCode": "29720-0418",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "704-975-0222",
    "MailingAddressFaxNumber": "704-235-1621",
    "FirstLinePracticeLocationAddress": "9456 CHARLOTTE HWY STE 104",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "INDIAN LAND",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29707-7953",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "803-839-0406",
    "PracticeLocationAddressFaxNumber": "704-235-1621",
    "EnumerationDate": "10/23/2024",
    "LastUpdateDate": "10/23/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "EVANS",
    "AuthorizedOfficialFirstName": "ANTHONY",
    "AuthorizedOfficialMiddleName": "JAMES",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DPT",
    "AuthorizedOfficialTelephoneNumber": "803-839-0406",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QP2000X",
        "TaxonomyName": "Physical Therapy Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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