Provider Demographics
NPI:1033481940
Name:EVANS, ANNA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:EVANS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 HARWOOD CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-8416
Mailing Address - Country:US
Mailing Address - Phone:407-344-0630
Mailing Address - Fax:
Practice Address - Street 1:4641 OLD CANOE CREEK RD
Practice Address - Street 2:PLANTATION BAY REHABILITATION CENTER
Practice Address - City:ST. CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769
Practice Address - Country:US
Practice Address - Phone:407-892-7344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 5909225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist