Provider Demographics
NPI:1720479694
Name:RODELA, EVELYN P (PT, DPT)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:P
Last Name:RODELA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 893
Mailing Address - Street 2:
Mailing Address - City:FABENS
Mailing Address - State:TX
Mailing Address - Zip Code:79838-0893
Mailing Address - Country:US
Mailing Address - Phone:915-309-3417
Mailing Address - Fax:915-231-2288
Practice Address - Street 1:1700 E CLIFF DR
Practice Address - Street 2:STE 101
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5192
Practice Address - Country:US
Practice Address - Phone:915-500-6601
Practice Address - Fax:915-500-6603
Is Sole Proprietor?:No
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1255765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist