Individual
JONALD BOYLES EVANGELISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
3157 FAIRLANE DR, ALLEN PARK, MI 48101-2866
(313) 827-0099
(313) 749-0480
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(866) 370-8206
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
032653
NY
225100000X
Physical Therapist
Primary
4240
NV
Other
Enumeration date
11/13/2019
Last updated
10/31/2023
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