Provider Demographics
NPI:1235308552
Name:EGGERT, RICK (PTA)
Entity Type:Individual
Prefix:MR
First Name:RICK
Middle Name:
Last Name:EGGERT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:MR
Other - First Name:RICHARD
Other - Middle Name:JAMES
Other - Last Name:DECOURSY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:943 PALENCIA PL
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-8064
Mailing Address - Country:US
Mailing Address - Phone:619-392-1104
Mailing Address - Fax:
Practice Address - Street 1:1 CIVIC PLAZA DR
Practice Address - Street 2:SUITE 625
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2243
Practice Address - Country:US
Practice Address - Phone:310-549-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT-4725225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant