Provider Demographics
NPI:1336186642
Name:EVANS, DAWN E (PT)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:E
Last Name:EVANS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26 CONKEY AVE
Mailing Address - Street 2:BOX 136
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1756
Mailing Address - Country:US
Mailing Address - Phone:315-895-4016
Mailing Address - Fax:315-894-7326
Practice Address - Street 1:33 CENTRAL PLZ
Practice Address - Street 2:
Practice Address - City:ILION
Practice Address - State:NY
Practice Address - Zip Code:13357-1701
Practice Address - Country:US
Practice Address - Phone:315-895-4016
Practice Address - Fax:315-894-7326
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011584225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB7232Medicare PIN
NYS90661Medicare UPIN
NY650023534Medicare PIN