Provider Demographics
NPI:1568736908
Name:NGO, EVELYN (PT, DPT, CLT, WCC)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:NGO
Suffix:
Gender:F
Credentials:PT, DPT, CLT, WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2542 BABCOCK RD APT G204
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4868
Mailing Address - Country:US
Mailing Address - Phone:956-326-8226
Mailing Address - Fax:
Practice Address - Street 1:2542 BABCOCK RD APT G204
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4868
Practice Address - Country:US
Practice Address - Phone:956-326-8226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1171049174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist