Provider Demographics
NPI:1881169340
Name:EVANS, ROBERT (PT, DPT, CF-L2)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:PT, DPT, CF-L2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6276 SANDPIPER CT
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-1926
Mailing Address - Country:US
Mailing Address - Phone:612-226-7885
Mailing Address - Fax:
Practice Address - Street 1:383 W 60TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-2372
Practice Address - Country:US
Practice Address - Phone:612-226-7885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11255225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist