MEDICARE: NICOLE C EGGERS 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	4316-19	WI

General Provider Information

NPI Number	:	1790646610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE C EGGERS PTA

Provider Business Mailing Address
First Line	:	105 CLARMAR DR
Second Line	:
City	:	SUN PRAIRIE
State	:	WI
Zip	:	53590-2675
Country	:	US
Telephone Number	:	608-318-5929
Fax Number	:	608-318-5922

Provider Business Practice Location Address
First Line	:	3205 E WASHINGTON AVE STE 1
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53704-4332
Country	:	US
Telephone Number	:	608-886-9802
Fax Number	:	608-249-7728

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

Provider Enumeration Date	:	11/20/2025
Last Update Date	:	11/20/2025

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