Provider Demographics
NPI:1225704026
Name:EAVES, NIKOLE LEIGH (DPT, PT)
Entity Type:Individual
Prefix:
First Name:NIKOLE
Middle Name:LEIGH
Last Name:EAVES
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 DOWLEN RD STE L
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7285
Mailing Address - Country:US
Mailing Address - Phone:409-861-4606
Mailing Address - Fax:
Practice Address - Street 1:3050 DOWLEN RD STE L
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-7285
Practice Address - Country:US
Practice Address - Phone:409-861-4606
Practice Address - Fax:409-861-4608
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1350230208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation