Provider Demographics
NPI:1528795994
Name:EASTERLY, ALLISON (DPT)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:EASTERLY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4327 SUNSET BEACH CIR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-4820
Mailing Address - Country:US
Mailing Address - Phone:262-215-2963
Mailing Address - Fax:833-869-6437
Practice Address - Street 1:1402 CAT MAR RD STE A
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-8904
Practice Address - Country:US
Practice Address - Phone:262-215-2963
Practice Address - Fax:833-869-6437
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT39070225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist