Provider Demographics
NPI:1902159221
Name:EVANS, PATRICIA (PTA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DAYLILY
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-1442
Mailing Address - Country:US
Mailing Address - Phone:949-240-8441
Mailing Address - Fax:949-240-0536
Practice Address - Street 1:26284 OSO RD
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1629
Practice Address - Country:US
Practice Address - Phone:949-240-8441
Practice Address - Fax:949-240-0536
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT5854225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant