Provider Demographics
NPI:1518172345
Name:EVANS, JOHN PAUL III (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:EVANS
Suffix:III
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 1:96 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:JIM THORPE
Mailing Address - State:PA
Mailing Address - Zip Code:18229-9566
Mailing Address - Country:US
Mailing Address - Phone:386-405-6052
Mailing Address - Fax:
Practice Address - Street 1:96 WILLOW DR
Practice Address - Street 2:
Practice Address - City:JIM THORPE
Practice Address - State:PA
Practice Address - Zip Code:18229-9566
Practice Address - Country:US
Practice Address - Phone:386-405-6052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22088172M00000X
PAPT022518225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No172M00000XOther Service ProvidersMechanotherapist