Provider Demographics
NPI:1154767465
Name:EVANS, ALLISON K (LMT)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:K
Last Name:EVANS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:K
Other - Last Name:URBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:807 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-2471
Mailing Address - Country:US
Mailing Address - Phone:541-864-9808
Mailing Address - Fax:
Practice Address - Street 1:807 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-2471
Practice Address - Country:US
Practice Address - Phone:541-864-9808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15318225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist