Provider Demographics
NPI:1851456867
Name:EATON, LARRY CLINTON (PT)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:CLINTON
Last Name:EATON
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 1:27543 EVELYN AVE
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48183-4859
Mailing Address - Country:US
Mailing Address - Phone:734-671-0613
Mailing Address - Fax:
Practice Address - Street 1:12855 DIX TOLEDO RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1744
Practice Address - Country:US
Practice Address - Phone:734-283-2526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001069225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist