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General NPI Number Information
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NPI Number | 1114579224
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Entity Type | Individual
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Provider Name | MICHAEL EATON
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Gender | Male
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Dates
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Enumeration Date | 07/10/2019
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 133 MARKET CENTER WAY STE 2
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City | DALEVILLE
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State | VA
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Zip | 24083-3284
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Country | US
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Telephone | 540-242-3017
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 412307
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City | BOSTON
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State | MA
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Zip | 02241-2307
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Country | US
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Telephone | 914-294-4050
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Fax | 631-760-8306
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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 | 2305212390
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License Number State | VA
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