Provider Demographics
NPI:1992823876
Name:EVENS, TIMOTHY R (PT)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:R
Last Name:EVENS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:TIM
Other - Middle Name:
Other - Last Name:EVENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1821 NE BOBBIE CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6609
Mailing Address - Country:US
Mailing Address - Phone:541-285-7070
Mailing Address - Fax:520-884-0175
Practice Address - Street 1:2753 NW LOLO DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7288
Practice Address - Country:US
Practice Address - Phone:541-285-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2020-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5081225100000X
AZ10611225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR027916Medicaid
AZ858779Medicaid
AZZ163288Medicare PIN
ORR147385Medicare PIN