MEDICARE: MR. GREGORY DALLAS EASON PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT2442	AR

General Provider Information

NPI Number	:	1679899223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORY DALLAS EASON PT

Provider Business Mailing Address
First Line	:	2423 KAVANAUGH BLVD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-3902
Country	:	US
Telephone Number	:	501-580-4041
Fax Number	:

Provider Business Practice Location Address
First Line	:	2423 KAVANAUGH BLVD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-3902
Country	:	US
Telephone Number	:	501-580-4041
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2010
Last Update Date	:	04/07/2010

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