Individual
JEREMY BLAKE EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
1618 KIRBY RD, CARROLLTON, TX 75006-7453
(972) 245-1573
Mailing address
1618 KIRBY RD, CARROLLTON, TX 75006-7453
(972) 245-1573
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2065866
TX
Other
Enumeration date
08/05/2008
Last updated
08/05/2008
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