MEDICARE: SHEVONDA N EVANS LMT

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	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1205498698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEVONDA N EVANS LMT

Provider Business Mailing Address
First Line	:	2 OFFICE PARK CT STE 102B
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-5948
Country	:	US
Telephone Number	:	907-433-9529
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 OFFICE PARK CT STE 102B
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-5948
Country	:	US
Telephone Number	:	907-433-9529
Fax Number	:

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

Provider Enumeration Date	:	07/05/2019
Last Update Date	:	07/05/2019

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Directions to “ SHEVONDA N EVANS LMT” Practice Location

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