MEDICARE: TISHEEKA PATRICIA EVANS PT

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	024617	NY
2	225100000X	Physical Therapist	PT010950	GA

General Provider Information

NPI Number	:	1720395981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TISHEEKA PATRICIA EVANS PT

Provider Business Mailing Address
First Line	:	72-35 MYRTLE AVENUE APT 1F
Second Line	:
City	:	GELNDALE
State	:	NY
Zip	:	11385
Country	:	US
Telephone Number	:	516-680-5585
Fax Number	:

Provider Business Practice Location Address
First Line	:	1175 129TH ST
Second Line	:
City	:	COLLEGE POINT
State	:	NY
Zip	:	11356-1943
Country	:	US
Telephone Number	:	718-359-2966
Fax Number	:	718-359-2966

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

Provider Enumeration Date	:	09/09/2010
Last Update Date	:	06/30/2017

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