Provider Demographics
NPI:1649962549
Name:EVANS, AMITY RAE ARELLANO
Entity type:Individual
Prefix:
First Name:AMITY RAE
Middle Name:ARELLANO
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4456 SANIBEL CIR STE 404
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4694
Mailing Address - Country:US
Mailing Address - Phone:757-943-4300
Mailing Address - Fax:
Practice Address - Street 1:477 VIKING DR STE 430
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7349
Practice Address - Country:US
Practice Address - Phone:757-514-1915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306605153225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant