=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639716830
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EASTON OSBORN PT, DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2019
-----------------------------------------------------
Last Update Date | 01/12/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1211 VIRGINIA ST
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27401-1313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-275-0927
-----------------------------------------------------
Fax | 336-275-4834
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6934 WILLIAMS RD STE 700
-----------------------------------------------------
City | NIAGARA FALLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14304-3081
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-298-5903
-----------------------------------------------------
Fax | 719-297-4762
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | P20005
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------