=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588143077
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANTHONY JAMES EVANS DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2018
-----------------------------------------------------
Last Update Date | 01/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2585 W ROOSEVELT BLVD
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28110-0418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-839-0278
-----------------------------------------------------
Fax | 704-235-1621
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4231 SPADEFOOT CT
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29720-0418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-975-0222
-----------------------------------------------------
Fax | 704-235-1621
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 10795
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 17281
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------