Provider Demographics
NPI:1700251691
Name:EBERHART, PAUL HARRISON III
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:HARRISON
Last Name:EBERHART
Suffix:III
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 1:938 SHADLE RD
Mailing Address - Street 2:
Mailing Address - City:JERSEY SHORE
Mailing Address - State:PA
Mailing Address - Zip Code:17740-9134
Mailing Address - Country:US
Mailing Address - Phone:570-745-2301
Mailing Address - Fax:
Practice Address - Street 1:938 SHADLE RD
Practice Address - Street 2:
Practice Address - City:JERSEY SHORE
Practice Address - State:PA
Practice Address - Zip Code:17740-9134
Practice Address - Country:US
Practice Address - Phone:570-745-2301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT022451225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist