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General NPI Number Information
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NPI Number | 1104379957
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Entity Type | Individual
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Provider Name | JOHN EARLS PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 07/28/2016
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Last Update Date | 09/27/2018
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Provider Practice Location Address
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Address Line | 2812 VINE ST STE 300
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City | DALLAS
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State | TX
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Zip | 75204-4091
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Country | US
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Telephone | 469-626-7254
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Fax |
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Provider Business Mailing Address
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Address Line | 1408 N RIVERFRONT BLVD # 211
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City | DALLAS
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State | TX
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Zip | 75207-3912
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Country | US
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Telephone | 802-505-5013
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Fax | 214-237-1283
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 040.0120310
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License Number State | VT
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