Provider Demographics
NPI:1629678685
Name:BARNES, EVAN
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:BARNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8627 CINNAMON CREEK DR BLDG 402
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1480
Mailing Address - Country:US
Mailing Address - Phone:106-532-4222
Mailing Address - Fax:210-653-2400
Practice Address - Street 1:7909 PAT BOOKER RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-2602
Practice Address - Country:US
Practice Address - Phone:210-653-2400
Practice Address - Fax:210-653-2422
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
TX1337352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist