Provider Demographics
NPI:1376693762
Name:EATON, JEREMY CLARKE (PT, MS, BS)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:CLARKE
Last Name:EATON
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Gender:M
Credentials:PT, MS, BS
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Mailing Address - Street 1:3051 WATSON BLVD
Mailing Address - Street 2:SUITE 525
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-8556
Mailing Address - Country:US
Mailing Address - Phone:478-953-4563
Mailing Address - Fax:478-953-4564
Practice Address - Street 1:3051 WATSON BLVD
Practice Address - Street 2:SUITE 525
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-8556
Practice Address - Country:US
Practice Address - Phone:478-953-4563
Practice Address - Fax:478-953-4564
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2015-07-17
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Provider Licenses
StateLicense IDTaxonomies
GAPT067772251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic