Provider Demographics
NPI:1336475037
Name:SHUTE, EVAN THOMAS (DPT)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:THOMAS
Last Name:SHUTE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 S 39TH ST
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-1413
Mailing Address - Country:US
Mailing Address - Phone:503-961-2443
Mailing Address - Fax:509-249-8706
Practice Address - Street 1:111 S 3RD ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2827
Practice Address - Country:US
Practice Address - Phone:509-249-8704
Practice Address - Fax:509-249-8706
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60104049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist