Provider Demographics
NPI:1679737795
Name:EVANS, LINDA MARIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
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 1:23100 EUCALYPTUS AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-5439
Mailing Address - Country:US
Mailing Address - Phone:951-529-1988
Mailing Address - Fax:951-379-1501
Practice Address - Street 1:2091 W FLORIDA AVE STE 210
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-4800
Practice Address - Country:US
Practice Address - Phone:951-658-0005
Practice Address - Fax:951-658-0009
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 34763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA122198Medicare PIN
CACB215140Medicare PIN
CACB215140Medicare PIN