Provider Demographics
NPI:1225005317
Name:EVENSON, JULIE (PT)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:
Last Name:EVENSON
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 1:629 BRACKETT RD
Mailing Address - Street 2:
Mailing Address - City:SANBORNVILLE
Mailing Address - State:NH
Mailing Address - Zip Code:03872-4231
Mailing Address - Country:US
Mailing Address - Phone:603-973-1608
Mailing Address - Fax:
Practice Address - Street 1:60 ROCHESTER HILL RD
Practice Address - Street 2:SUITE 8
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3235
Practice Address - Country:US
Practice Address - Phone:603-335-4700
Practice Address - Fax:603-335-4704
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH08Y009941NH01OtherANTHEM
NHRE8605Medicare ID - Type Unspecified