Provider Demographics
NPI:1346388055
Name:EVANS, CONSTANCE (PT, LAC)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:PT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-2306
Mailing Address - Country:US
Mailing Address - Phone:207-594-5553
Mailing Address - Fax:
Practice Address - Street 1:236 CEDAR ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2306
Practice Address - Country:US
Practice Address - Phone:207-594-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC243171100000X
MEPT2707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist