Individual
TOM EVANICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T. A.
Contact information
Practice address
1603 CHASE RD, LOGANSPORT, IN 46947-1538
(574) 737-7404
Mailing address
4324 GRANDVIEW DR, LOGANSPORT, IN 46947-4106
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06002169A
IN
Other
Enumeration date
04/13/2007
Last updated
07/08/2007
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