Provider Demographics
NPI:1073545687
Name:EVANS, EDWARD COPELAN II (LAT, ATC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:COPELAN
Last Name:EVANS
Suffix:II
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 MR ED LN
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-6435
Mailing Address - Country:US
Mailing Address - Phone:318-352-7656
Mailing Address - Fax:
Practice Address - Street 1:468 CASPARI ST
Practice Address - Street 2:ATHLETIC FIELDHOUSE, N. S. U.
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71497-0003
Practice Address - Country:US
Practice Address - Phone:318-357-4035
Practice Address - Fax:318-357-4045
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAATH.J000282255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer