| NPI | 1972834182 |
|---|---|
| Former Name | STACEY LYNN EVANS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P18328) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 23119) |
| Enumeration Date | 2010-01-28 |
| Last Update Date | 2020-11-02 |