Provider Demographics
NPI:1780893479
Name:FLAMENCO, EVELYN (PTA)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:FLAMENCO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3454
Mailing Address - Country:US
Mailing Address - Phone:978-762-3513
Mailing Address - Fax:
Practice Address - Street 1:3 BURLINGTON WOODS
Practice Address - Street 2:SUITE 304
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4514
Practice Address - Country:US
Practice Address - Phone:781-270-0222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7828225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant