Provider Demographics
NPI:1912272683
Name:EACHES, JUSTIN ALLEN (ATC)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:ALLEN
Last Name:EACHES
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2984 COUNTY ROAD 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-8832
Mailing Address - Country:US
Mailing Address - Phone:304-638-3168
Mailing Address - Fax:
Practice Address - Street 1:2828 1ST AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1236
Practice Address - Country:US
Practice Address - Phone:304-525-6905
Practice Address - Fax:304-529-6880
Is Sole Proprietor?:No
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT.0028012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer