Provider Demographics
NPI:1043096845
Name:SIA, EDUARDO M III (DPT)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:M
Last Name:SIA
Suffix:III
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3424
Mailing Address - Country:US
Mailing Address - Phone:732-766-2107
Mailing Address - Fax:
Practice Address - Street 1:420 E 120TH AVE
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80233-1127
Practice Address - Country:US
Practice Address - Phone:303-280-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCP029811T225100000X
NJ40QA01944000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist