MEDICARE: ROY J EGGART PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	973	WI

General Provider Information

NPI Number	:	1700860418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROY J EGGART PTA

Provider Business Mailing Address
First Line	:	700 WEST AVE S
Second Line	:
City	:	LA CROSSE
State	:	WI
Zip	:	54601-4783
Country	:	US
Telephone Number	:	608-791-4156
Fax Number	:	608-791-9898

Provider Business Practice Location Address
First Line	:	520 AMY DR
Second Line	:
City	:	HOLMEN
State	:	WI
Zip	:	54636-9337
Country	:	US
Telephone Number	:	608-526-3351
Fax Number	:	608-526-3412

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	01/19/2021

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Directions to “ ROY J EGGART PTA” Practice Location

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