| Doctor Name: | BEN MICHAEL EVARDOME |
| NPI Number: | 1164754875 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PTA |
| License Number: | AT6602 |
| Business Practice Address: | 34835 Fairport Way Yucaipa, CA - 923996817 |
| Business Phone Number: | 9095709573 |
| Business Fax Number: | 9095709573 |
| Mailing Address: | 34835 Fairport Way, YUCAIPA |
| State: | CA |
| Postal Code: | 923996817 |
| Phone Number: | 9095709573 |
| Fax Number: | 9095709573 |
| NPI Enumeration Date: | 02/04/2010 |
| NPI Last Update Date: | 02/04/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225200000X |
| License Number: | AT6602 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapy Assistant |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1)Physical therapist assistants are skilled health care providers who are graduates of a physical therapist assistant associate degree program accredited by an agency recognized by the Secretary of the U.S. Department of Education or Council on Postsecondary Accreditation, who assists the physical therapist in providing physical therapy. The supervising physical therapist is directly responsible for the actions of the physical therapist assistant. The PTA performs physical therapy procedures and related tasks that have been selected and delegated by the supervising physical therapist. Duties of the PTA include assisting the physical therapist in implementing treatment programs, training patients in exercised and activities of daily living, conducting treatments, and reporting to the physical therapist on the patient |