Nicole Evanosky, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT012689L Issued in PA

Practice address

5 Jacquelyn LN
Dallas, PA 18612-9107

Phone

(570) 574-1930

NPI assigned

Aug 5, 2021

Last updated

Aug 5, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cip Rehabilitation Inc

  • Occupational Therapist
  • Dallas, PA
  • NPI 1669963039

  Physical Therapist

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1628121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628121600000",
    "number": "1093489668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 JACQUELYN LN",
            "city": "DALLAS",
            "state": "PA",
            "postal_code": "186129107",
            "telephone_number": "570-574-1930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 JACQUELYN LN",
            "city": "DALLAS",
            "state": "PA",
            "postal_code": "186129107",
            "telephone_number": "570-574-1930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANOSKY",
        "first_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-05",
        "last_updated": "2021-08-05",
        "certification_date": "2021-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT012689L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sean Alexander Dowling
• Jane E Durkin, D.O.
• Shianna Marie Duvall
• Ecumenical Enterprises Inc (Meadows Nursing and Rehabilitation Center)
• Erika D Eisenbach, P.T., D.P.T
• Angela Mary Evans, CRNP
• Mindy Lee Evans
• Eye Care Specialists, P.C.
• Katie M Ferguson, PHARMD
• Stephanie Fischer, LSW

• Physical Therapist in Dallas, PA
• Providers in Dallas, PA by specialty
• Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.