Provider Demographics
NPI:1033996046
Name:BOCKOVER, EVAN JOSEPH (PT, DPT)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:JOSEPH
Last Name:BOCKOVER
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 PARKRIDGE RD APT A5
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9316
Mailing Address - Country:US
Mailing Address - Phone:812-593-6558
Mailing Address - Fax:
Practice Address - Street 1:3708 MAYFAIR ST STE 110
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6223
Practice Address - Country:US
Practice Address - Phone:984-215-5090
Practice Address - Fax:984-215-5095
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCP-CP024446T225100000X
IN05015193A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist