Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Ben Michael Evardome, PTA

Individual provider Physical Therapy Assistant · NPI 1164754875

Ben Michael Evardome, PTA is a Physical Therapy Assistant in Yucaipa, California. Practices as a sole proprietor. Licensed in California.

Licensed in
CA
In the registry since
2010
What do these letters mean?
PTA — Physical Therapist Assistant
Delivers treatment under a physical therapist's direction.

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Practice location Address checks out

34835 Fairport Way
Yucaipa, CA 92399-6817
Phone: (909) 570-9573
Fax: (909) 570-9573
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Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence AT6602 (CA)

Record details

NPI number1164754875
Entity typeIndividual (Type 1)
GenderMale
Credentials PTA
Sole proprietorYes
NPI enumeratedFebruary 4, 2010
Last updated in NPPESFebruary 4, 2010
Mailing address34835 Fairport Way, Yucaipa, CA 92399-6817

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