Provider Demographics
NPI:1972668820
Name:HARN, EVELYN JOAN (LMT)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:JOAN
Last Name:HARN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
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Mailing Address - Street 1:1790 POMELO DRIVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-2716
Mailing Address - Country:US
Mailing Address - Phone:941-493-8596
Mailing Address - Fax:941-493-8596
Practice Address - Street 1:1540 BAY SHORE RD
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275
Practice Address - Country:US
Practice Address - Phone:941-485-8904
Practice Address - Fax:941-485-4684
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLMA17155225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist