Provider Demographics
NPI:1316817406
Name:WEGENAST, EVAN JOSEPH (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:JOSEPH
Last Name:WEGENAST
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 BRECKENRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4904
Mailing Address - Country:US
Mailing Address - Phone:502-537-7440
Mailing Address - Fax:502-537-7441
Practice Address - Street 1:128 BRECKENRIDGE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4904
Practice Address - Country:US
Practice Address - Phone:502-537-7440
Practice Address - Fax:502-537-7441
Is Sole Proprietor?:No
Enumeration Date:2025-11-05
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0095052251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic