Provider Demographics
NPI:1275787962
Name:EGGLESTON, HEATHER DIAN (LMT)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:DIAN
Last Name:EGGLESTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CHARLOTTE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-3646
Mailing Address - Country:US
Mailing Address - Phone:904-829-0590
Mailing Address - Fax:904-824-0790
Practice Address - Street 1:40 CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-3646
Practice Address - Country:US
Practice Address - Phone:904-829-0590
Practice Address - Fax:904-824-0790
Is Sole Proprietor?:No
Enumeration Date:2008-11-08
Last Update Date:2008-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA49735172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist