# DR. EVAN TIRTAPUTRA

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1083001234
- **Gender:** Man
- **Credential:** DPT

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 27800 | MD | Yes |
| 225100000X | Physical Therapist | J1-0003931 | DE | — |
| 225100000X | Physical Therapist | PT-3844 | ID | — |

## Other

- **Enumeration date:** 04/24/2015
- **Last updated:** 11/26/2019