Provider Demographics
NPI:1700157088
Name:EVITT, CELINDA P (PT, PHD, GCS)
Entity type:Individual
Prefix:DR
First Name:CELINDA
Middle Name:P
Last Name:EVITT
Suffix:
Gender:F
Credentials:PT, PHD, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6309 N 20TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-3522
Mailing Address - Country:US
Mailing Address - Phone:813-931-5025
Mailing Address - Fax:813-931-5025
Practice Address - Street 1:6309 N 20TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-3522
Practice Address - Country:US
Practice Address - Phone:813-931-5025
Practice Address - Fax:813-931-5025
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT1368225100000X, 2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY4342AOtherMEDICARE