Provider Demographics
NPI:1740629997
Name:EVANGELISTA, DENISE D (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:D
Last Name:EVANGELISTA
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 1:31709 VALLEY FORGE ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-8135
Mailing Address - Country:US
Mailing Address - Phone:209-406-0538
Mailing Address - Fax:
Practice Address - Street 1:10783 JAMACHA BLVD
Practice Address - Street 2:#7
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978-1842
Practice Address - Country:US
Practice Address - Phone:619-670-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist