Individual
DR. EVAN TIRTAPUTRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
137 W HIGH ST STE 3, ELKTON, MD 21921
(410) 392-7027
(410) 392-5768
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2222
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
27800
MD
225100000X
Physical Therapist
J1-0003931
DE
225100000X
Physical Therapist
PT-3844
ID
Other
Enumeration date
04/24/2015
Last updated
11/26/2019
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