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General NPI Number Information
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NPI Number | 1841939220
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Entity Type | Individual
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Provider Name | ZACHARY J EAGLE PT
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Gender | Male
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Dates
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Enumeration Date | 06/02/2022
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Last Update Date | 06/02/2022
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Provider Practice Location Address
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Address Line | 2009 S MAIN ST
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City | MOSCOW
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State | ID
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Zip | 83843-8913
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Country | US
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Telephone | 208-618-8430
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Fax |
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Provider Business Mailing Address
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Address Line | 947 NW HOQUIAM CT
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City | CAMAS
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State | WA
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Zip | 98607-8154
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Country | US
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Telephone | 360-852-2466
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-8244
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License Number State | ID
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