KELLY NICOLE EVANOVICH (NPI# 1114274313) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114274313 |
| Entity Type | Individual |
| Full Name | KELLY NICOLE EVANOVICH |
| Credential | PT, DPT, ATC |
| Practice Address |
900 Northrop Rd Wallingford CT 06492-1997 |
| Mailing Address |
64 Groveland Ter Newington CT 06111-1614 |
| Practice Telephone | 2039491534 |
| Mailing Telephone | 8607980147 |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2012-08-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2251X0800X |
Physical Therapist Specialization: Orthopedic |
14.009513 | CT | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
900 NORTHROP RD |
| City | WALLINGFORD |
| State | CT |
| Zip Code | 06492-1997 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134158041 | Terrence Bugai | Emergency Medicine | 900 Northrop Rd, Wallingford, CT 06492-1997 | 2006-07-02 |
| 1386282119 | Nickolas Denuzzo | Physical Therapist | 900 Northrop Rd, Wallingford, CT 06492-1997 | 2019-12-11 |
| 1134672652 | David White | Physical Therapist | 900 Northrop Rd, Ste, D, Wallingford, CT 06492-1997 | 2016-08-02 |
| 1891180246 | Jose Leonardo Villa Uribe | Emergency Medicine | 900 Northrop Rd, Wallingford, CT 06492 | 2015-04-02 |
| 1396158226 | Jacquelyne Michelle Guerra | Registered Nurse | 900 Northrop Rd, Wallingford, CT 06492-1997 | 2014-06-09 |
| 1982964599 | Jacqueline E Anglin-dixon | Pharmacist | 900 Northrop Rd, Wallingford, CT 06492-1997 | 2012-05-17 |
| 1427347244 | Victoria Ione Canary | Physical Therapist | 900 Northrop Rd, Wallingford, CT 06492-1997 | 2011-04-01 |
| 1225155369 | Paul Acampora | Preventive Medicine | 900 Northrop Rd, Wallingford, CT 06492-1997 | 2007-03-23 |
| 1851418859 | Kathryn M Papadikis | Preventive Medicine | 900 Northrop Rd, Wallingford, CT 06492-1997 | 2007-03-23 |
| 1457478984 | John Mark Farrell | Physician Assistant | 900 Northrop Rd, Wallingford, CT 06492 | 2007-03-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891310215 | The Promptcare Companies, Inc. | Durable Medical Equipment & Medical Supplies | 101 Noth Plains Industrial Park, Suite B Building 2 Harvest Park, Wallingford, CT 06492 | 2020-06-11 |
| 1528692480 | Hilary Caitlin Sullivan | Nurse Practitioner | Park Avenue Medical, LLC, 85 Barnes Road, Suite 202, Wallingford, CT 06492 | 2020-02-28 |
| 1902370943 | Alicia Anne Eldridge | Student in an Organized Health Care Education/Training Program | 88 Cheshire Road, Wallingford, CT 06492 | 2019-01-13 |
| 1114409562 | Doreen Gail Barile | Pharmacist | 846 North Colony Road, Wallingford, CT 06492 | 2018-09-02 |
| 1942782354 | Brad Becker | Pharmacist | 846 North Colony Rd, Walingford, CT 06492 | 2018-08-31 |
| 1477041564 | Melissa A Fazzolari | Nurse Practitioner | 850 N Main Street Ext Ste B, Wallingford, CT 06492 | 2018-04-25 |
| 1992235857 | Karen Ann Meers | Behavioral Analyst | 29 North Plains Highway, Unit 15, Wallingford, CT 06492 | 2017-06-14 |
| 1992232698 | Chelsea Clements | Occupational Therapist | 87 Southwind Dr, Wallingford, CT 06492 | 2017-05-12 |
| 1659822369 | Sara Frawley | Naturopath | 850 N. Main Street Extention, Building 2 Suite 3c, Wallingford, CT 06492 | 2016-10-18 |
| 1083085518 | Energetic Spine Chiropractic | Chiropractor | 1271 South Broad St., Unit #11, Wallingford, CT 06492 | 2015-10-09 |
| Find all providers in zip 06492 | ||||
| Taxonomy Code | 2251X0800X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Physical Therapist |
| Specialization | Orthopedic |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528434867 | Laura Berndt | Physical Therapist | 850 N Main Street Ext, Wallingford, CT 06492-2400 | 2015-08-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245837384 | Connecticut Back Center LLC | Physical Therapist | 460 Hartford Tpke Ste B, Vernon, CT 06066-4847 | 2020-10-01 |
| 1780290882 | Jacob Chwiedz | Physical Therapist | 179 Linwood Ave Unit A-4, Colchester, CT 06415-1160 | 2020-09-23 |
| 1578174488 | Michael G Giambrone | Physical Therapist | 19 Old Kings Hwy S, Darien, CT 06820-4533 | 2020-08-13 |
| 1841809373 | Connecticut Orthopaedic Specialists, PC | Physical Therapist | 3 Liesl Ln, Branford, CT 06405-3036 | 2020-07-30 |
| 1093227902 | Nicholas A Bessette | Physical Therapist | 140 Main St Ste 4b, Middletown, CT 06457-3437 | 2017-11-01 |
| 1588051510 | Physical Therapy Arts LLC | Physical Therapist | 96 Rt. 37, New Fairfield, CT 06812 | 2015-04-16 |
| 1578954459 | Shanya Stearns | Physical Therapist | 65a Albany Tpke, Canton, CT 06019-2507 | 2015-02-12 |
| 1497145536 | Tiffany Sudol | Physical Therapist | 1445 E Putnam Ave Ste 2, Old Greenwich, CT 06870-1377 | 2015-01-28 |
| 1093115404 | Core Balance Physical Therapy, LLC | Physical Therapist | 22 Knapp St, Suite 303, Stamford, CT 06907-1700 | 2014-09-04 |
| 1730440736 | Michael James Staropoli | Physical Therapist | 1555 Post Rd E, Westport, CT 06880-5671 | 2012-06-06 |
| Find all providers with the same taxonomy | ||||
| City | WALLINGFORD |
| Zip Code | 06492 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.