Provider Demographics
NPI:1144770223
Name:EASTBERG, EMILY O (DPT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:O
Last Name:EASTBERG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:C
Other - Last Name:OJEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1187 SANDLER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-9432
Mailing Address - Country:US
Mailing Address - Phone:561-339-1297
Mailing Address - Fax:850-644-4251
Practice Address - Street 1:960 LEARNING WAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32306-2173
Practice Address - Country:US
Practice Address - Phone:850-644-7133
Practice Address - Fax:850-644-4251
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32006225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT32006OtherSTATE PHYSICAL THERAPY LICENSE