Provider Demographics
NPI:1104041458
Name:EVANS, DEAN DAVID JR (PT)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:DAVID
Last Name:EVANS
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E ROWAN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1214
Mailing Address - Country:US
Mailing Address - Phone:509-484-0095
Mailing Address - Fax:509-484-0477
Practice Address - Street 1:124 E ROWAN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1214
Practice Address - Country:US
Practice Address - Phone:509-484-0095
Practice Address - Fax:509-484-0477
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7100431Medicaid
WAAB14875Medicare ID - Type Unspecified
WA7100431Medicaid