Provider Demographics
NPI:1558098665
Name:EVANS, ELISABETH JOY (LMT)
Entity Type:Individual
Prefix:MS
First Name:ELISABETH
Middle Name:JOY
Last Name:EVANS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40662 GERMAN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PAONIA
Mailing Address - State:CO
Mailing Address - Zip Code:81428-6102
Mailing Address - Country:US
Mailing Address - Phone:970-773-4728
Mailing Address - Fax:
Practice Address - Street 1:110 S. 7TH STREET, UNIT B
Practice Address - Street 2:
Practice Address - City:HOTCHKISS
Practice Address - State:CO
Practice Address - Zip Code:81419-0508
Practice Address - Country:US
Practice Address - Phone:970-872-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.008027225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist