Provider Demographics
NPI:1932185725
Name:EUBANKS, CHARLES (PT)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:EUBANKS
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 1:2244 PALISADES CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-6402
Mailing Address - Country:US
Mailing Address - Phone:845-358-7828
Mailing Address - Fax:845-358-4484
Practice Address - Street 1:2244 PALISADES CENTER DR
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-6402
Practice Address - Country:US
Practice Address - Phone:845-358-7828
Practice Address - Fax:845-358-4484
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist