Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 05008689A | IN |
NPI | 1124224407 |
---|---|
Provider Name | Mr. Carl Owen Eaton |
First Address | Indianapolis, IN 46260-6601 |
Second Address | Indianapolis, IN 46204-3610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2007 |
Last Update Date | 08/07/2007 |