Provider Demographics
NPI:1730676438
Name:EVANS, ELIZABETH LAURA (CMT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LAURA
Last Name:EVANS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:LAURA
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT
Mailing Address - Street 1:2145 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-5870
Mailing Address - Country:US
Mailing Address - Phone:530-534-5394
Mailing Address - Fax:530-534-3820
Practice Address - Street 1:2145 5TH AVE
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-5870
Practice Address - Country:US
Practice Address - Phone:530-534-5394
Practice Address - Fax:530-534-5394
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist