Provider Demographics
NPI:1578042578
Name:EVANS, NEVAH MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:NEVAH
Middle Name:MARIE
Last Name:EVANS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212B RICHARDS ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-3942
Mailing Address - Country:US
Mailing Address - Phone:979-412-9477
Mailing Address - Fax:
Practice Address - Street 1:343 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:TX
Practice Address - Zip Code:77836-2328
Practice Address - Country:US
Practice Address - Phone:979-567-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2138871225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant