Provider Demographics
NPI:1740607415
Name:BIRCHARD, EVAN WESLEY (DPT)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:WESLEY
Last Name:BIRCHARD
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 19TH ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-2768
Mailing Address - Country:US
Mailing Address - Phone:530-448-6202
Mailing Address - Fax:
Practice Address - Street 1:5 HARRIS CT
Practice Address - Street 2:BUILDING T SUITE 102
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5750
Practice Address - Country:US
Practice Address - Phone:831-372-3579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist