Provider Demographics
NPI:1700026507
Name:EGLAND, ROGER GILLMAN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:GILLMAN
Last Name:EGLAND
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:STORM LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50588-1607
Mailing Address - Country:US
Mailing Address - Phone:712-732-5382
Mailing Address - Fax:
Practice Address - Street 1:700 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:IA
Practice Address - Zip Code:50574-2206
Practice Address - Country:US
Practice Address - Phone:712-335-3386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist