Provider Demographics
NPI:1013110402
Name:EVANS, TINA MICHELLE
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MICHELLE
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 W OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3286
Mailing Address - Country:US
Mailing Address - Phone:630-428-1184
Mailing Address - Fax:630-305-6157
Practice Address - Street 1:535 W OGDEN AVE
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3286
Practice Address - Country:US
Practice Address - Phone:630-428-1184
Practice Address - Fax:630-305-6157
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant