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General NPI Number Information
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NPI Number | 1699358176
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Entity Type | Individual
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Provider Name | HEATHER RENEE EVANS DPT
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Gender | Female
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Dates
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Enumeration Date | 05/03/2021
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Last Update Date | 05/03/2021
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Provider Practice Location Address
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Address Line | 157 HOME AVE
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City | DARLINGTON
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State | SC
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Zip | 29532-7625
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Country | US
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Telephone | 843-393-2867
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Fax |
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Provider Business Mailing Address
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Address Line | 5575 SCHELLIN DR
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City | DALZELL
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State | SC
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Zip | 29040-9415
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Country | US
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Telephone | 804-837-5055
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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 | 10645
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License Number State | SC
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