Provider Demographics
NPI:1912451279
Name:EVANS, KORATRONA BOIJONA-ELIZABETH (DPT)
Entity Type:Individual
Prefix:
First Name:KORATRONA
Middle Name:BOIJONA-ELIZABETH
Last Name:EVANS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5300 DERRY ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-3576
Mailing Address - Country:US
Mailing Address - Phone:717-839-2110
Mailing Address - Fax:717-565-1102
Practice Address - Street 1:3 JENNIFER CT
Practice Address - Street 2:SUITE A
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-7791
Practice Address - Country:US
Practice Address - Phone:717-243-0271
Practice Address - Fax:717-243-0531
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPT025446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist