Provider Demographics
NPI:1659858561
Name:LOBATO, EVAN (ATC)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:LOBATO
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7730 HARKINS RD APT 337
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-1338
Mailing Address - Country:US
Mailing Address - Phone:732-615-7143
Mailing Address - Fax:
Practice Address - Street 1:7730 HARKINS RD APT 337
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-1338
Practice Address - Country:US
Practice Address - Phone:732-615-7143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00010592255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer