Provider Demographics
NPI:1194205724
Name:HAIRR, EVAN WELLS (PT)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:WELLS
Last Name:HAIRR
Suffix:
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 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-682-8840
Mailing Address - Fax:
Practice Address - Street 1:17230 US HIGHWAY 17 STE 218
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-7466
Practice Address - Country:US
Practice Address - Phone:910-821-1506
Practice Address - Fax:910-821-1508
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP18239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist