Provider Demographics
NPI:1437273448
Name:TEMPLETON, EVA M (LMBT, CNT)
Entity Type:Individual
Prefix:MRS
First Name:EVA
Middle Name:M
Last Name:TEMPLETON
Suffix:
Gender:F
Credentials:LMBT, CNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 LISBON LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-4844
Mailing Address - Country:US
Mailing Address - Phone:704-598-1060
Mailing Address - Fax:
Practice Address - Street 1:1101 SOUTH BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4237
Practice Address - Country:US
Practice Address - Phone:704-371-3288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5195225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist