| Dr Evan Tirtaputra, DPT | |
|
137 W High St Ste 3, Elkton, MD 21921 | |
| (410) 392-7027 | |
| (410) 392-5768 |
| Full Name | Dr Evan Tirtaputra |
|---|---|
| Gender | Male |
| Speciality | Physical Therapist |
| Location | 137 W High St Ste 3, Elkton, Maryland |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083001234 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | PT-3844 (Idaho) | Secondary |
| 225100000X | Physical Therapist | 27800 (Maryland) | Primary |
| 225100000X | Physical Therapist | J1-0003931 (Delaware) | Secondary |
| Provider Name | Huntington Orthopedic Surgical Group |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1851465603 PECOS PAC ID: 8224026596 Enrollment ID: O20040505000088 |
| Provider Name | Good Day Physical Therapy Pc |
|---|---|
| Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
| Provider Identifiers | NPI Number: 1730768011 PECOS PAC ID: 9638570930 Enrollment ID: O20211123003330 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Evan Tirtaputra, DPT 790 Remington Blvd, Bolingbrook, IL 60440-4909 Ph: (630) 296-2222 | Dr Evan Tirtaputra, DPT 137 W High St Ste 3, Elkton, MD 21921 Ph: (410) 392-7027 |
Mrs. Janelle Kristen Antonio, DPT, OCS Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 107 Chesapeake Blvd, Suite 100, Elkton, MD 21921 Phone: 410-392-9400 Fax: 410-392-0577 | |
Paula Marie Giannaras, PT Physical Therapist Medicare: Medicare Enrolled Practice Location: 112 Paige Ln, Elkton, MD 21921 Phone: 410-920-8463 | |
Maryann Taft, PT Physical Therapist Medicare: Medicare Enrolled Practice Location: 139 E High St, Elkton, MD 21921 Phone: 410-392-2731 Fax: 410-392-2732 | |
Kathleen Lester Lechette, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 201 Booth St, Elkton, MD 21921 Phone: 410-996-5450 | |
Ms. Heather E Wray, PT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 107 Chesapeake Blvd, Suite 100, Elkton, MD 21921 Phone: 410-392-9400 Fax: 410-392-0577 | |
Maryanne Snyder, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 913 N Bridge St, Elkton, MD 21921 Phone: 410-392-2731 Fax: 410-392-2732 |