Provider Demographics
NPI:1831168707
Name:EATON, JEFFREY LEE (MPT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LEE
Last Name:EATON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20815 N 25TH PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-4616
Mailing Address - Country:US
Mailing Address - Phone:602-374-2760
Mailing Address - Fax:602-351-8184
Practice Address - Street 1:20815 N 25TH PL
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4616
Practice Address - Country:US
Practice Address - Phone:602-374-2760
Practice Address - Fax:602-351-8184
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS83619Medicare UPIN
AZ107731Medicare ID - Type Unspecified