Provider Demographics
NPI:1497424105
Name:ESHETU, YONATAN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:YONATAN
Middle Name:
Last Name:ESHETU
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 TILBURY PL
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-1222
Mailing Address - Country:US
Mailing Address - Phone:678-862-4535
Mailing Address - Fax:
Practice Address - Street 1:1045 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1645
Practice Address - Country:US
Practice Address - Phone:404-254-0961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0155832251X0800X
GA2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic