Provider Demographics
NPI:1285385971
Name:EVANS, CARSEN
Entity type:Individual
Prefix:
First Name:CARSEN
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 N 800 EAST RD
Mailing Address - Street 2:
Mailing Address - City:TOWER HILL
Mailing Address - State:IL
Mailing Address - Zip Code:62571-8213
Mailing Address - Country:US
Mailing Address - Phone:121-741-2850
Mailing Address - Fax:
Practice Address - Street 1:11 HAWTHORNE LN
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IL
Practice Address - Zip Code:61951-9490
Practice Address - Country:US
Practice Address - Phone:217-728-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant