Provider Demographics
NPI:1942237128
Name:EVANS, JENNIFER LYNN (ATC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:EVANS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 APPLE LN
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18214-2903
Mailing Address - Country:US
Mailing Address - Phone:570-467-2227
Mailing Address - Fax:
Practice Address - Street 1:300 SCHUYLKILL MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3668
Practice Address - Country:US
Practice Address - Phone:570-621-9500
Practice Address - Fax:570-621-9510
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001964A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer