Provider Demographics
NPI:1720395981
Name:EVANS, TISHEEKA PATRICIA (PT)
Entity Type:Individual
Prefix:
First Name:TISHEEKA
Middle Name:PATRICIA
Last Name:EVANS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72-35 MYRTLE AVENUE APT 1F
Mailing Address - Street 2:
Mailing Address - City:GELNDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385
Mailing Address - Country:US
Mailing Address - Phone:516-680-5585
Mailing Address - Fax:
Practice Address - Street 1:1175 129TH ST
Practice Address - Street 2:
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356-1943
Practice Address - Country:US
Practice Address - Phone:718-359-2966
Practice Address - Fax:718-359-2966
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024617225100000X
GAPT010950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist