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Individual
THOMAS DALE EVANS
Active
Individual
THOMAS DALE EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT0000010866
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000092766
—
AL
01
—
51512447
BLUECROSSBLUESHIELD OF AL
AL
01
—
P00039795
RAILROAD MEDICARE
AL
Enumeration date
08/04/2006
Last updated
10/17/2018
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