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General NPI Number Information
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NPI Number | 1568008944
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Entity Type | Individual
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Provider Name | EVA DE FIESTA PT
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Gender | Female
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Dates
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Enumeration Date | 11/21/2019
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Last Update Date | 11/21/2019
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Provider Practice Location Address
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Address Line | CAREFIRST REHAB 7225NOVA'S LANDING
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City | SELLERSBURG
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State | IN
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Zip | 47172
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Country | US
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Telephone | 812-748-7433
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Fax | 812-748-7442
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Provider Business Mailing Address
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Address Line | 105 ORCHARD HILLS DR APT 92
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-8281
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Country | US
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Telephone | 502-819-3765
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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 | 05013477A
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License Number State | IN
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