Individual
EVAN HATHAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
84 E GRANT ST STE 3, WOODSTOWN, NJ 08098-1400
(856) 769-4564
(856) 769-4637
Mailing address
PO BOX 146, WOODSTOWN, NJ 08098-0146
(856) 769-4564
(856) 769-4637
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
40QA01795800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
272918651
MEDICARE
—
Enumeration date
06/25/2018
Last updated
06/25/2018
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