Provider Demographics
NPI:1104894765
Name:EVORA, PAUL HENRY (MS, PT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:HENRY
Last Name:EVORA
Suffix:
Gender:M
Credentials:MS, PT
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Mailing Address - Street 1:430 W 24TH ST
Mailing Address - Street 2:APT 1F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1328
Mailing Address - Country:US
Mailing Address - Phone:718-544-3620
Mailing Address - Fax:
Practice Address - Street 1:430 W 24TH ST
Practice Address - Street 2:SUITE 1-F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1334
Practice Address - Country:US
Practice Address - Phone:212-741-5544
Practice Address - Fax:212-741-5895
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2018-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0202242251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ22R31Medicare ID - Type Unspecified