Provider Demographics
NPI:1649879891
Name:EVILSIZOR, BRITTANY D (LMT)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:D
Last Name:EVILSIZOR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2181 OLYMPIC ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2767
Mailing Address - Country:US
Mailing Address - Phone:937-390-9080
Mailing Address - Fax:937-390-9075
Practice Address - Street 1:2181 OLYMPIC ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2767
Practice Address - Country:US
Practice Address - Phone:937-390-9080
Practice Address - Fax:937-390-9075
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.021187225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist