Provider Demographics
NPI:1699002063
Name:EAVES, CHAD L (PT)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:L
Last Name:EAVES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E MAIN ST
Mailing Address - Street 2:501 EAST MAIN STREET
Mailing Address - City:LOUISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39339-2737
Mailing Address - Country:US
Mailing Address - Phone:662-773-3700
Mailing Address - Fax:662-773-3727
Practice Address - Street 1:501 E MAIN ST
Practice Address - Street 2:501 EAST MAIN STREET
Practice Address - City:LOUISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39339-2737
Practice Address - Country:US
Practice Address - Phone:662-773-3700
Practice Address - Fax:662-773-3727
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist