Provider Demographics
NPI:1972143279
Name:EVANS, KATRINA (PT, DPT)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
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 1:1750 WAVERLEY OAK DR
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-9916
Mailing Address - Country:US
Mailing Address - Phone:980-475-0322
Mailing Address - Fax:
Practice Address - Street 1:1030 MALL LOOP RD
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-7656
Practice Address - Country:US
Practice Address - Phone:336-841-2985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP16007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist