Provider Demographics
NPI:1386197309
Name:EADY, LOU NELL (DPT)
Entity Type:Individual
Prefix:
First Name:LOU NELL
Middle Name:
Last Name:EADY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 NE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-2041
Mailing Address - Country:US
Mailing Address - Phone:864-525-2654
Mailing Address - Fax:
Practice Address - Street 1:1500 TRAILHEAD CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29617-6226
Practice Address - Country:US
Practice Address - Phone:864-371-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist