Provider Demographics
NPI:1114683117
Name:SLAUGHTER, EVANN (PT, DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:EVANN
Middle Name:
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4870 DORSEY HALL DR UNIT 5
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7716
Mailing Address - Country:US
Mailing Address - Phone:301-861-9237
Mailing Address - Fax:
Practice Address - Street 1:8885 CENTRE PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2199
Practice Address - Country:US
Practice Address - Phone:410-730-1275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-14
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28730225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist