Provider Demographics
NPI:1043530264
Name:EATON, TABATHA C (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:TABATHA
Middle Name:C
Last Name:EATON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:TABATHA
Other - Middle Name:C
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:221 AVONDALE CIR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-1526
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:221 AVONDALE CIR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-1526
Practice Address - Country:US
Practice Address - Phone:478-951-0687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist