Provider Demographics
NPI:1174550966
Name:EVANS, CRYSTAL LEE (ATC/L)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:LEE
Last Name:EVANS
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3876 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-1095
Mailing Address - Country:US
Mailing Address - Phone:850-557-0475
Mailing Address - Fax:850-994-9794
Practice Address - Street 1:3876 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-1095
Practice Address - Country:US
Practice Address - Phone:850-557-0475
Practice Address - Fax:850-994-9794
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer