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Individual

EVAN QUEEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PTA

Contact information

Practice address
2825 CARTER RD, SUMTER, SC 29150-1712
(803) 469-4032
Mailing address
14 RILEY ST, SUMTER, SC 29150-4717
(803) 236-1707

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
837
SC

Other

Enumeration date
08/09/2012
Last updated
08/09/2012
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