Basic Information
| Provider Information | |||||||||
| NPI: | 1760795314 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 NEW FIDELITY CT | ||||||||
| Address2: | |||||||||
| City: | GARNER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275292665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197563107 | ||||||||
| FaxNumber: | 9195353271 | ||||||||
| Practice Location | |||||||||
| Address1: | 90 CROSSROAD HILL RD | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287163703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284920592 | ||||||||
| FaxNumber: | 8284920593 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2010 | ||||||||
| LastUpdateDate: | 05/02/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 23133 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | P17823 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.