Basic Information
| Provider Information | |||||||||
| NPI: | 1194015818 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21211 UNICORN LN | ||||||||
| Address2: | |||||||||
| City: | ROLAND | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721359611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5018681719 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 EXECUTIVE CENTER CT STE 110 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722114376 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016644933 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2011 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT1545 | AR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.