Provider Demographics
NPI:1912914532
Name:KAGAWA, EVELYN JOY (PT)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:JOY
Last Name:KAGAWA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2365
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:CA
Mailing Address - Zip Code:93644-2365
Mailing Address - Country:US
Mailing Address - Phone:559-683-4444
Mailing Address - Fax:559-683-7053
Practice Address - Street 1:48677 VICTORIA LN
Practice Address - Street 2:SUITE 101
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-9216
Practice Address - Country:US
Practice Address - Phone:559-683-4444
Practice Address - Fax:559-683-7053
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ66243ZOtherBLUE SHIELD
P43249Medicare UPIN
ZZZ03492ZMedicare ID - Type Unspecified
ZZZ66243ZOtherBLUE SHIELD