Provider Demographics
NPI:1144726928
Name:EVANS PHYSICAL THERAPY & SPORT PERFORMANCE, LLC
Entity type:Organization
Organization Name:EVANS PHYSICAL THERAPY & SPORT PERFORMANCE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:704-975-0222
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:MINERAL SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28108-0404
Mailing Address - Country:US
Mailing Address - Phone:704-975-0222
Mailing Address - Fax:
Practice Address - Street 1:2585 W ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-0418
Practice Address - Country:US
Practice Address - Phone:704-993-6941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy