Provider Demographics
NPI:1063255982
Name:PASSALINQUA, EVAN ROSS (DPT)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:ROSS
Last Name:PASSALINQUA
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 1:1599 N HERMITAGE RD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3180
Mailing Address - Country:US
Mailing Address - Phone:724-662-1776
Mailing Address - Fax:724-662-1858
Practice Address - Street 1:1599 N HERMITAGE RD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3180
Practice Address - Country:US
Practice Address - Phone:724-662-1776
Practice Address - Fax:724-662-1858
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT032273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist