Healthcare Provider Details

I. General information

NPI: 1154145092
Provider Name (Legal Business Name): EASTON JAMES FREEMAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 ACTIVE WAY
BENTON AR
72022-9267
US

IV. Provider business mailing address

160 LORENE ST
AUSTIN AR
72007-9143
US

V. Phone/Fax

Practice location:
  • Phone: 501-315-0984
  • Fax:
Mailing address:
  • Phone: 501-208-7814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT5575
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: