Individual
JONATHAN EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
12722 TONKEL RD STE 102, FORT WAYNE, IN 46845-8201
(260) 739-0300
Mailing address
11170 RILLITO LN, 301, FORT WAYNE, IN 46845-2079
(260) 570-8239
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
05011654A
IN
2251X0800X
Orthopedic Physical Therapist
PT010453
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201289270
—
IN
Enumeration date
10/01/2011
Last updated
06/25/2020
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