Provider Demographics
NPI:1194015818
Name:EVANS, ANGELA KAY (PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:KAY
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 1:21211 UNICORN LN
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72135-9611
Mailing Address - Country:US
Mailing Address - Phone:501-868-1719
Mailing Address - Fax:
Practice Address - Street 1:1 EXECUTIVE CENTER CT STE 110
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4376
Practice Address - Country:US
Practice Address - Phone:501-664-4933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist