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NPI Code Detail

MEDICARE: ROY J EGGART PTA

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
1225200000XPhysical Therapy Assistant973WI

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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