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NPI Code Detail

MEDICARE: DR. ALEXANDER JERROLD EGGEN DPT

MEDICARE: DR. ALEXANDER JERROLD EGGEN DPT
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
1225100000XPhysical Therapist14606-24WI

General Provider Information

NPI Number : 1003474065
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALEXANDER JERROLD EGGEN DPT
Provider Business Mailing Address
First Line : 113 4TH AVE
Second Line :
City : SHELL LAKE
State : WI
Zip : 54871-4457
Country : US
Telephone Number : 715-468-7833
Fax Number :
Provider Business Practice Location Address
First Line : 113 4TH AVE
Second Line :
City : SHELL LAKE
State : WI
Zip : 54871-4457
Country : US
Telephone Number : 715-468-7833
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2019
Last Update Date : 06/04/2019

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