Provider Demographics
NPI:1104592161
Name:EAKER, JAMES JOSEPH
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:JOSEPH
Last Name:EAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 GLEN BURNIE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-3011
Mailing Address - Country:US
Mailing Address - Phone:919-780-9784
Mailing Address - Fax:
Practice Address - Street 1:2908 GLEN BURNIE DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-3011
Practice Address - Country:US
Practice Address - Phone:919-780-9784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA7142225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant