Individual
MRS. EMILY IDA EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, ATC, CMT
Contact information
Practice address
1501 LAKESIDE DR, LYNCHBURG, VA 24501-3113
(434) 544-8649
Mailing address
1501 LAKESIDE DR, LYNCHBURG, VA 24501-3113
(434) 544-8649
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126000379
VA
Other
Enumeration date
12/13/2012
Last updated
12/13/2012
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