Individual
DAVID J. EVANGELISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
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
Update your record
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