Provider Demographics
NPI:1447968748
Name:EVANS-WASHINGTON, ADRIAN (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:EVANS-WASHINGTON
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 FOREST PARK BLVD STE 1E
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-2257
Mailing Address - Country:US
Mailing Address - Phone:682-990-2158
Mailing Address - Fax:
Practice Address - Street 1:2501 FOREST PARK BLVD STE 1E
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-2257
Practice Address - Country:US
Practice Address - Phone:682-990-2158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT045885225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist