MEDICARE: COURTNEY EVANS-WALL 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	033928-01	NY

General Provider Information

NPI Number	:	1275490120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY EVANS-WALL LMT

Provider Business Mailing Address
First Line	:	19135 116TH AVE
Second Line	:
City	:	SAINT ALBANS
State	:	NY
Zip	:	11412-3101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5513 MERRICK RD
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-6215
Country	:	US
Telephone Number	:	516-541-8933
Fax Number	:

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

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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Directions to “ COURTNEY EVANS-WALL LMT” Practice Location

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