Provider Demographics
NPI:1861105736
Name:EATON, MATTHEW JOSEPH (DPT)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:EATON
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 1:205 WHEATFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DUSON
Mailing Address - State:LA
Mailing Address - Zip Code:70529-4217
Mailing Address - Country:US
Mailing Address - Phone:337-212-1367
Mailing Address - Fax:
Practice Address - Street 1:1202 3RD ST W
Practice Address - Street 2:
Practice Address - City:ROUNDUP
Practice Address - State:MT
Practice Address - Zip Code:59072-1816
Practice Address - Country:US
Practice Address - Phone:406-323-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10155225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist