Provider Demographics
NPI:1144889403
Name:PARADIS, EVAN MARK (BS ATC)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:MARK
Last Name:PARADIS
Suffix:
Gender:M
Credentials:BS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MIDDLE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:ME
Mailing Address - Zip Code:04468-1480
Mailing Address - Country:US
Mailing Address - Phone:207-659-9621
Mailing Address - Fax:
Practice Address - Street 1:100 MIDDLE ST APT 1
Practice Address - Street 2:
Practice Address - City:OLD TOWN
Practice Address - State:ME
Practice Address - Zip Code:04468-1480
Practice Address - Country:US
Practice Address - Phone:207-659-9621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT4592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer