Provider Demographics
NPI:1740613413
Name:EVANS, BRYAN EDWARD (DPT,PT)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:EDWARD
Last Name:EVANS
Suffix:
Gender:M
Credentials:DPT,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 N SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012
Mailing Address - Country:US
Mailing Address - Phone:816-331-9111
Mailing Address - Fax:
Practice Address - Street 1:402 E GREGORY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131
Practice Address - Country:US
Practice Address - Phone:816-444-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013028594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist