Provider Demographics
NPI:1710441597
Name:EVENS, JUSTINE D
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:D
Last Name:EVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7770 SPRINGVILLE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-1696
Mailing Address - Country:US
Mailing Address - Phone:361-222-6206
Mailing Address - Fax:
Practice Address - Street 1:7770 SPRINGVILLE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-1696
Practice Address - Country:US
Practice Address - Phone:361-222-6206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer