Provider Demographics
NPI:1265490049
Name:DOUGLASS, ERIC ELDON (PT, DPT, OCS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ELDON
Last Name:DOUGLASS
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9920 COLONIAL WALK S
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6258
Mailing Address - Country:US
Mailing Address - Phone:239-947-4184
Mailing Address - Fax:239-947-4171
Practice Address - Street 1:25241 ELEMENTARY WAY
Practice Address - Street 2:STE 200
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-7883
Practice Address - Country:US
Practice Address - Phone:239-947-4184
Practice Address - Fax:239-947-4171
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT7380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY6192ZMedicare UPIN