Provider Demographics
NPI:1508916271
Name:CARLSON, EVANGELINE M (PT,DPT)
Entity Type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:M
Last Name:CARLSON
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 LEON ST APT 109
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-4634
Mailing Address - Country:US
Mailing Address - Phone:956-533-5070
Mailing Address - Fax:
Practice Address - Street 1:2108 S M ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1555
Practice Address - Country:US
Practice Address - Phone:956-668-7433
Practice Address - Fax:956-668-7183
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1070803225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist