Individual
DAVID J. EVANGELISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2 ESSEX CENTER DR, PEABODY, MA 01960-2902
(978) 977-4115
Mailing address
147 MILK ST, PROVIDER ENROLLMENT 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8051
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
16591
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
908025
TUFTS HEALTH PLAN
MA
01
—
B501027
CIGNA
MA
01
—
HV0001
HARVARD PILGRIM
MA
01
—
VX2347
MEDICARE PTAN
MA
Enumeration date
09/20/2006
Last updated
05/12/2008
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