Provider Demographics
NPI:1689291221
Name:EASTERLING, ETHAN HARDY (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:HARDY
Last Name:EASTERLING
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-541-5492
Mailing Address - Fax:
Practice Address - Street 1:695 N PRESTON RD STE 140
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009-3925
Practice Address - Country:US
Practice Address - Phone:972-382-8551
Practice Address - Fax:972-382-8553
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20000285852255A2300X
TX1331648225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer