MEDICARE: PROF. CHRISTIAN C EVANS P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist		IL

General Provider Information

NPI Number	:	1093931461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. CHRISTIAN C EVANS P.T.

Provider Business Mailing Address
First Line	:	21W742 GLEN VALLEY DR
Second Line	:
City	:	GLEN ELLYN
State	:	IL
Zip	:	60137-7041
Country	:	US
Telephone Number	:	630-534-6160
Fax Number	:	630-515-7224

Provider Business Practice Location Address
First Line	:	555 31ST ST
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1235
Country	:	US
Telephone Number	:	630-515-7249
Fax Number	:	630-515-7224

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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