Provider Demographics
NPI:1215912498
Name:CLELAND, ERIC F (PT)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:F
Last Name:CLELAND
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 1:1983 COMMERCE CENTER CIR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-4454
Mailing Address - Country:US
Mailing Address - Phone:928-771-1700
Mailing Address - Fax:928-771-9900
Practice Address - Street 1:1983 COMMERCE CENTER CIR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-4454
Practice Address - Country:US
Practice Address - Phone:928-771-1700
Practice Address - Fax:928-771-9900
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPT 8290225100000X
AZ5626225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ679951Medicaid