Provider Demographics
NPI:1295869394
Name:EVANS, CHRISTINE (MSPT)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 GAZEBO LN
Mailing Address - Street 2:
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1640
Mailing Address - Country:US
Mailing Address - Phone:631-289-4750
Mailing Address - Fax:
Practice Address - Street 1:44 GAZEBO LN
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1640
Practice Address - Country:US
Practice Address - Phone:631-289-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022912-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ07B41Medicare ID - Type Unspecified