Individual
BEN MICHAEL EVARDOME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
34835 FAIRPORT WAY, YUCAIPA, CA 92399-6817
(909) 570-9573
(909) 570-9573
Mailing address
34835 FAIRPORT WAY, YUCAIPA, CA 92399-6817
(909) 570-9573
(909) 570-9573
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT6602
CA
Other
Enumeration date
02/04/2010
Last updated
02/04/2010
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