Provider Demographics
NPI:1295743540
Name:EVANS, BETTY WARING (BSPT)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:WARING
Last Name:EVANS
Suffix:
Gender:F
Credentials:BSPT
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:PAGE
Other - Last Name:WARING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12700 TAYLORS VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:LOVETTSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20180-2255
Mailing Address - Country:US
Mailing Address - Phone:540-822-9057
Mailing Address - Fax:
Practice Address - Street 1:43 PANAMA STREET
Practice Address - Street 2:
Practice Address - City:HARPERS FERRY
Practice Address - State:WV
Practice Address - Zip Code:25425
Practice Address - Country:US
Practice Address - Phone:304-535-2400
Practice Address - Fax:304-535-2424
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2494225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1104834431OtherWORKERS COMPENSATION