Provider Demographics
NPI:1104379957
Name:EARLS, JOHN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:EARLS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 N RIVERFRONT BLVD # 211
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75207-3912
Mailing Address - Country:US
Mailing Address - Phone:802-505-5013
Mailing Address - Fax:214-237-1283
Practice Address - Street 1:2812 VINE ST STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-4091
Practice Address - Country:US
Practice Address - Phone:469-626-7254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT040.0120310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist