Provider Demographics
NPI:1710318613
Name:EDDINGTON, ALEESHA (PTA)
Entity Type:Individual
Prefix:
First Name:ALEESHA
Middle Name:
Last Name:EDDINGTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6171
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32314-6171
Mailing Address - Country:US
Mailing Address - Phone:504-258-9696
Mailing Address - Fax:
Practice Address - Street 1:3700 CAPITAL CIR SE
Practice Address - Street 2:APT 102
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-2702
Practice Address - Country:US
Practice Address - Phone:504-258-9696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2100523225200000X
VA2306603732225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant