Active NPI
Fred L. Evans III, PTA
- Physical Therapy Assistant
- Florence, SC
National Provider Identifier
1497229124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 3241
- Practice address
- 2439 Willwood Dr.
Florence, SC 29501 - Phone
- (843) 777-2196
- NPI assigned
- Jan 16, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 3241 | SC | Primary |
Addresses
Primary practice location
2439 Willwood Dr.
Florence, SC 29501
Mailing address
P.O Box 1116
Lamar, SC 29069
Phone (843) 616-4488
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3241 | SC | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547596800000",
"number": "1497229124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O BOX 1116",
"city": "LAMAR",
"state": "SC",
"postal_code": "29069",
"telephone_number": "843-616-4488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2439 WILLWOOD DR.",
"city": "FLORENCE",
"state": "SC",
"postal_code": "29501",
"telephone_number": "843-777-2196"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "FRED",
"middle_name": "L.",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-01-16",
"last_updated": "2019-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "SC",
"license": "3241",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Florence, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.