Provider Demographics
NPI:1669963583
Name:EASH, SETH G (DPT)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:G
Last Name:EASH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 J PL
Mailing Address - Street 2:
Mailing Address - City:KALONA
Mailing Address - State:IA
Mailing Address - Zip Code:52247-9719
Mailing Address - Country:US
Mailing Address - Phone:319-330-4905
Mailing Address - Fax:
Practice Address - Street 1:1405 J PL
Practice Address - Street 2:
Practice Address - City:KALONA
Practice Address - State:IA
Practice Address - Zip Code:52247-9719
Practice Address - Country:US
Practice Address - Phone:319-330-4905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
IA0921532255A2300X
IA105668225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer