Provider Demographics
NPI:1700914678
Name:EATON, DENNIS HERMAN (PT)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:HERMAN
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 1:2442 SE 101ST AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-3060
Mailing Address - Country:US
Mailing Address - Phone:503-235-5500
Mailing Address - Fax:503-595-0454
Practice Address - Street 1:2442 SE 101ST AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-3060
Practice Address - Country:US
Practice Address - Phone:503-235-5500
Practice Address - Fax:503-595-0454
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1895225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist