Provider Demographics
NPI:1356057483
Name:SMITTENAAR, EVELYN (PTA)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:SMITTENAAR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7556 TEAGUE RD STE 240
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1389
Mailing Address - Country:US
Mailing Address - Phone:410-768-5555
Mailing Address - Fax:
Practice Address - Street 1:7556 TEAGUE RD STE 240
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1389
Practice Address - Country:US
Practice Address - Phone:410-768-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5775225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant