Provider Demographics
NPI:1295098986
Name:EMALA, EVAN CHARLES (PTA)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:CHARLES
Last Name:EMALA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1089 NUMIDIA DR
Mailing Address - Street 2:
Mailing Address - City:CATAWISSA
Mailing Address - State:PA
Mailing Address - Zip Code:17820-8627
Mailing Address - Country:US
Mailing Address - Phone:570-799-5050
Mailing Address - Fax:
Practice Address - Street 1:1089 NUMIDIA DR
Practice Address - Street 2:
Practice Address - City:CATAWISSA
Practice Address - State:PA
Practice Address - Zip Code:17820-8627
Practice Address - Country:US
Practice Address - Phone:570-799-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE009131225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant