Provider Demographics
NPI:1215769484
Name:EVEY FORTIN LMT LLC
Entity type:Organization
Organization Name:EVEY FORTIN LMT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE (EVEY)
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:479-422-7895
Mailing Address - Street 1:2426 MADISON 6001
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:AR
Mailing Address - Zip Code:72727-8492
Mailing Address - Country:US
Mailing Address - Phone:479-422-7895
Mailing Address - Fax:
Practice Address - Street 1:2863 E MILLENNIUM DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-6513
Practice Address - Country:US
Practice Address - Phone:479-444-7332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty