Provider Demographics
NPI:1013046721
Name:HELLWIG, EVAN V (PHD, ATC, PT)
Entity type:Individual
Prefix:MR
First Name:EVAN
Middle Name:V
Last Name:HELLWIG
Suffix:
Gender:M
Credentials:PHD, ATC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 WELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45506-3751
Mailing Address - Country:US
Mailing Address - Phone:937-323-3329
Mailing Address - Fax:
Practice Address - Street 1:251 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CEDARVILLE
Practice Address - State:OH
Practice Address - Zip Code:45314-8501
Practice Address - Country:US
Practice Address - Phone:937-766-7691
Practice Address - Fax:937-766-2795
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04208225100000X
OH0006062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer