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NPI Code Detail

MEDICARE: MRS. KRISTAL EVANS PTA

MEDICARE: MRS. KRISTAL EVANS PTA
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
1225200000XPhysical Therapy AssistantAT3964CA

General Provider Information

NPI Number : 1114319688
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTAL EVANS PTA
Provider Business Mailing Address
First Line : 911 MORAGA RD STE 103
Second Line :
City : LAFAYETTE
State : CA
Zip : 94549-4591
Country : US
Telephone Number : 925-284-3840
Fax Number :
Provider Business Practice Location Address
First Line : 911 MORAGA RD STE 103
Second Line :
City : LAFAYETTE
State : CA
Zip : 94549-4591
Country : US
Telephone Number : 925-284-3840
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2015
Last Update Date : 02/20/2015

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Directions to “ MRS. KRISTAL EVANS PTA” Practice Location

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