Provider Demographics
NPI:1447322730
Name:EVANS, RODGER A (DPT)
Entity type:Individual
Prefix:MR
First Name:RODGER
Middle Name:A
Last Name:EVANS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 PALOMINO HORSE TRAIL
Mailing Address - Street 2:
Mailing Address - City:BIG PINE KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33043
Mailing Address - Country:US
Mailing Address - Phone:305-304-4585
Mailing Address - Fax:
Practice Address - Street 1:133 PALOMINO HORSE TRAIL
Practice Address - Street 2:
Practice Address - City:BIG PINE KEY
Practice Address - State:FL
Practice Address - Zip Code:33043
Practice Address - Country:US
Practice Address - Phone:305-304-4585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010336225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHT234ZMedicare PIN