Kelly Nicole Evanovich, PT, DPT, ATC

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

14.009513 Issued in CT

Practice address

900 Northrop Rd
Wallingford, CT 06492-1997

Phone

(203) 949-1534

NPI assigned

Aug 7, 2012

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1344297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344297600000",
    "number": "1114274313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64 GROVELAND TER",
            "city": "NEWINGTON",
            "state": "CT",
            "postal_code": "061111614",
            "telephone_number": "860-798-0147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 NORTHROP RD",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064921997",
            "telephone_number": "203-949-1534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANOVICH",
        "first_name": "KELLY",
        "middle_name": "NICOLE",
        "credential": "PT, DPT, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-08-07",
        "last_updated": "2012-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "CT",
            "license": "14.009513",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsey Ertel, DPT
• Kristine Alexi Escobar, APRN
• Ryan Esposito
• Etherapy of Connecticut, LLC
• Moira Ethier, MS
• Vanessa Joyce Matuod Evardone, M.D.
• Evolve Counseling & Consultationllc
• Eye & Vision Clinic
• Eye Health Professionals, P.C.
• Sophia Fagan

• Orthopedic Physical Therapist in Wallingford, CT
• Providers in Wallingford, CT by specialty
• Orthopedic Physical Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.