Provider Demographics
NPI:1760795314
Name:EVANS, MATTHEW CHRISTOPHER (DPT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:CHRISTOPHER
Last Name:EVANS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-756-3107
Mailing Address - Fax:919-535-3271
Practice Address - Street 1:90 CROSSROAD HILL RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NC
Practice Address - Zip Code:28716-3703
Practice Address - Country:US
Practice Address - Phone:828-492-0592
Practice Address - Fax:828-492-0593
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD23133225100000X
NCP17823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist