Provider Demographics
NPI:1124677919
Name:THERAPY TRAILS OF EVANS
Entity type:Organization
Organization Name:THERAPY TRAILS OF EVANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SLP
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PEAVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-842-3330
Mailing Address - Street 1:536 GRAND SLAM DR STE D
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-8045
Mailing Address - Country:US
Mailing Address - Phone:706-854-8434
Mailing Address - Fax:706-854-8435
Practice Address - Street 1:536 GRAND SLAM DR STE D
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-8045
Practice Address - Country:US
Practice Address - Phone:706-854-8434
Practice Address - Fax:706-854-8435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
706-854-8434OtherPHONE NUMBER