Provider Demographics
NPI:1417936766
Name:EVANS, MICHAEL DUANE (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DUANE
Last Name:EVANS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 BOARDWALK
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6332
Mailing Address - Country:US
Mailing Address - Phone:405-447-1991
Mailing Address - Fax:405-447-1198
Practice Address - Street 1:2475 BOARDWALK
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6332
Practice Address - Country:US
Practice Address - Phone:405-447-1991
Practice Address - Fax:405-447-1198
Is Sole Proprietor?:No
Enumeration Date:2006-01-14
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT3574225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist