MEDICARE: DR. RICHARD LEE EASTER PT, DPT, OCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT0000013430	TN

General Provider Information

NPI Number	:	1396325353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD LEE EASTER PT, DPT, OCS

Provider Business Mailing Address
First Line	:	3135 PEOPLES ST STE 404
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-4138
Country	:	US
Telephone Number	:	423-454-1006
Fax Number	:

Provider Business Practice Location Address
First Line	:	3135 PEOPLES ST STE 404
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-4138
Country	:	US
Telephone Number	:	423-454-1006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2021
Last Update Date	:	04/13/2021

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