Healthcare Provider Details

I. General information

NPI: 1225704026
Provider Name (Legal Business Name): NIKOLE LEIGH EAVES DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 08/20/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 DOWLEN RD STE L
BEAUMONT TX
77706-7285
US

IV. Provider business mailing address

3050 DOWLEN RD STE L
BEAUMONT TX
77706-7285
US

V. Phone/Fax

Practice location:
  • Phone: 409-861-4606
  • Fax: 409-861-4608
Mailing address:
  • Phone: 409-861-4606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1350230
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: