Individual
MRS. MARY BETH EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1169 EASTERN PKWY, SUITE 2313, LOUISVILLE, KY 40217-1417
(502) 309-9800
(502) 309-9797
Mailing address
PO BOX 3276, EVANSVILLE, IN 47731-3276
(812) 473-0181
(812) 473-5822
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
001579
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000964014
ANTHEM BCBS
KY
01
—
001579
LICENSE
KY
01
—
002124
CERTIFICATION - LYMPHOLOGY ASSOCIATION OF NORTH AMERICA
—
05
—
87015798
—
KY
Enumeration date
01/17/2007
Last updated
08/17/2020
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