Provider Demographics
NPI:1629588983
Name:EVANS, CARLY (PTA)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:COLLURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:914 MASON TUCKER DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-5986
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8353 HIGHWAY 100
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-4190
Practice Address - Country:US
Practice Address - Phone:629-888-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-01
Last Update Date:2017-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6461225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant