Provider Demographics
NPI:1871246488
Name:EVANS, ZACHARY CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:CHRISTOPHER
Last Name:EVANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334-1807
Mailing Address - Country:US
Mailing Address - Phone:320-334-1314
Mailing Address - Fax:
Practice Address - Street 1:626 SHIELDS AVE
Practice Address - Street 2:
Practice Address - City:WABASHA
Practice Address - State:MN
Practice Address - Zip Code:55981-1142
Practice Address - Country:US
Practice Address - Phone:651-565-4581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA2736225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant