| Doctor Name: | MARK HENRY EVENINGRED |
| NPI Number: | 1861592784 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.P.T. |
| License Number: | 5501005092 |
| Business Practice Address: | 17900 23 Mile Rd Ste 401 Macomb, MI - 480441161 |
| Business Phone Number: | 5868689040 |
| Business Fax Number: | 5868689013 |
| Mailing Address: | 48675 American Elm Dr, MACOMB |
| State: | MI |
| Postal Code: | 480441429 |
| Phone Number: | 5862634910 |
| Fax Number: | |
| NPI Enumeration Date: | 09/22/2006 |
| NPI Last Update Date: | 10/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 5501005092 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |