Provider Demographics
NPI:1982195541
Name:HEALY, EVAN DANIEL (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:DANIEL
Last Name:HEALY
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ANNAWON RD
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-4946
Mailing Address - Country:US
Mailing Address - Phone:508-566-1122
Mailing Address - Fax:
Practice Address - Street 1:579 BUCK ISLAND RD
Practice Address - Street 2:
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-3200
Practice Address - Country:US
Practice Address - Phone:508-957-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-19
Last Update Date:2018-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA23584225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist