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General NPI Number Information
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NPI Number | 1720395981
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Entity Type | Individual
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Provider Name | TISHEEKA PATRICIA EVANS PT
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Gender | Female
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Dates
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Enumeration Date | 09/09/2010
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Last Update Date | 06/30/2017
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Provider Practice Location Address
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Address Line | 1175 129TH ST
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City | COLLEGE POINT
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State | NY
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Zip | 11356-1943
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Country | US
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Telephone | 718-359-2966
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Fax | 718-359-2966
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Provider Business Mailing Address
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Address Line | 72-35 MYRTLE AVENUE APT 1F
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City | GELNDALE
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State | NY
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Zip | 11385
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Country | US
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Telephone | 516-680-5585
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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 | 024617
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT010950
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License Number State | GA
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