Provider Demographics
NPI:1386465169
Name:EVANS PHYSICAL THERAPY & SPORT PERFORMANCE, LLC
Entity type:Organization
Organization Name:EVANS PHYSICAL THERAPY & SPORT PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:803-839-0406
Mailing Address - Street 1:4231 SPADEFOOT CT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-0418
Mailing Address - Country:US
Mailing Address - Phone:704-975-0222
Mailing Address - Fax:704-235-1621
Practice Address - Street 1:9456 CHARLOTTE HWY STE 104
Practice Address - Street 2:
Practice Address - City:INDIAN LAND
Practice Address - State:SC
Practice Address - Zip Code:29707-7953
Practice Address - Country:US
Practice Address - Phone:803-839-0406
Practice Address - Fax:704-235-1621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy