Provider Demographics
NPI:1275062978
Name:MURRY, EVAN LABARGE
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:LABARGE
Last Name:MURRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 MCQUEEN SMITH RD N STE D
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-5663
Mailing Address - Country:US
Mailing Address - Phone:334-358-6501
Mailing Address - Fax:
Practice Address - Street 1:635 MCQUEEN SMITH RD N STE D
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-5663
Practice Address - Country:US
Practice Address - Phone:334-358-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA7887225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant