Provider Demographics
NPI:1780845628
Name:EVANKO, BARBARA W (MS, PT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:W
Last Name:EVANKO
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-8850
Mailing Address - Fax:610-859-7876
Practice Address - Street 1:674 UNIONVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-4712
Practice Address - Country:US
Practice Address - Phone:610-925-4856
Practice Address - Fax:610-925-4859
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102379116-0001Medicaid
PA30070460OtherKEYSTONE MERCY
PA002123074OtherHIGHMARK PABS
306143OtherUNISON
PA3740718000OtherIBC
PA102379116-0001Medicaid