La'Toria Evans, LPTA

Individual provider Active NPI Physical Therapy Assistant · Wiggins, MS

NPI 1225488281 · NPPES record last updated Oct 29, 2019

Key facts

NPI
1225488281
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapy Assistant 225200000X
License
PTA 4590 (MS)
Practice address
1434 Central Ave E
Wiggins, MS 39577-9602
Phone
(601) 928-1889
NPI assigned
Jun 20, 2016
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
PTA 4590MSMDPhysical Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X PTA 4590 MS Yes

Addresses

Primary practice location

1434 Central Ave E
Wiggins, MS 39577-9602

Mailing address

1436 Central Ave E
Wiggins, MS 39577-9602

Other practice location 1

2279 Atkinson Rd
Biloxi, MS 39531-2209
Phone (228) 388-1805

Other providers in Wiggins, MS

All providers in Wiggins, MS · Physical Therapy Assistant in Mississippi

Sources for this page

Verify at the official NPI Registry.