Provider Demographics
NPI:1598753709
Name:EGGEBRECHT, MELANIE M (PT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:M
Last Name:EGGEBRECHT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:PHILLIPS
Mailing Address - State:WI
Mailing Address - Zip Code:54555
Mailing Address - Country:US
Mailing Address - Phone:715-339-6140
Mailing Address - Fax:888-412-1366
Practice Address - Street 1:187 S LAKE AVENUE
Practice Address - Street 2:
Practice Address - City:PHILLIPS
Practice Address - State:WI
Practice Address - Zip Code:54555
Practice Address - Country:US
Practice Address - Phone:715-339-6140
Practice Address - Fax:888-412-1366
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9889225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40384000Medicaid