Provider Demographics
NPI:1134987977
Name:EVELIUS, THERESA ANNE (ATC)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:ANNE
Last Name:EVELIUS
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 1:86 HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-8025
Mailing Address - Country:US
Mailing Address - Phone:717-524-6952
Mailing Address - Fax:717-632-2422
Practice Address - Street 1:207 BLOOMING GROVE RD STE A
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-7917
Practice Address - Country:US
Practice Address - Phone:717-812-7559
Practice Address - Fax:717-632-2422
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0048382255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer