Provider Demographics
NPI:1619613874
Name:SMITH, EVAN CLAY (DPT)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:CLAY
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14800 W MOUNTAIN VIEW BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-4797
Mailing Address - Country:US
Mailing Address - Phone:623-556-5013
Mailing Address - Fax:623-556-9290
Practice Address - Street 1:14800 W MOUNTAIN VIEW BLVD STE 260
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4797
Practice Address - Country:US
Practice Address - Phone:623-556-5013
Practice Address - Fax:623-556-9290
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT323362251G0304X, 2251N0400X, 2251S0007X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports