Provider Demographics
NPI:1972941987
Name:EVANS, CHRISTOPHER COLEMAN (LMT, RMT)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:COLEMAN
Last Name:EVANS
Suffix:
Gender:M
Credentials:LMT, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 STALLION CT
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-0575
Mailing Address - Country:US
Mailing Address - Phone:720-302-3807
Mailing Address - Fax:
Practice Address - Street 1:267 W CAUSEWAY APPROACH
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-3032
Practice Address - Country:US
Practice Address - Phone:720-302-3807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8834225700000X
LA8218225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist