Provider Demographics
NPI:1710324348
Name:EVERLY, KATIE (DPT)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:
Last Name:EVERLY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8675 BANDO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5375
Mailing Address - Country:US
Mailing Address - Phone:177-978-3363
Mailing Address - Fax:
Practice Address - Street 1:401 N BUFFALO DR STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-0397
Practice Address - Country:US
Practice Address - Phone:702-818-5000
Practice Address - Fax:702-818-5001
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
NV3357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist