Provider Demographics
NPI:1750988150
Name:EVANS, JAMIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:EVANS
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 1:1013 HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-4012
Mailing Address - Country:US
Mailing Address - Phone:817-999-7277
Mailing Address - Fax:
Practice Address - Street 1:1241 CROSS TIMBERS RD
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1272
Practice Address - Country:US
Practice Address - Phone:972-691-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1192159225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist