Healthcare Provider Details

I. General information

NPI: 1073603320
Provider Name (Legal Business Name): PAUL EATON PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13995 CLAYTON RD
TOWN AND COUNTRY MO
63017-8400
US

IV. Provider business mailing address

584 PRAIRIE HOME DR
SAINT PETERS MO
63376-5014
US

V. Phone/Fax

Practice location:
  • Phone: 636-227-5070
  • Fax:
Mailing address:
  • Phone: 636-970-6368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number02229
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: