Provider Demographics
NPI:1417350711
Name:EVANS, KATIE ELIZABETH (PTA)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:ELIZABETH
Last Name:EVANS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:ELIZABETH
Other - Last Name:GREENAWALT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1200 BRAUN RUN ROAD
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102
Mailing Address - Country:US
Mailing Address - Phone:412-854-5500
Mailing Address - Fax:412-854-4742
Practice Address - Street 1:1200 BRAUN RUN ROAD
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102
Practice Address - Country:US
Practice Address - Phone:412-854-5500
Practice Address - Fax:412-854-4742
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI001527225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant