Provider Demographics
NPI:1700860418
Name:EGGART, ROY J (PTA)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:J
Last Name:EGGART
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 WEST AVE S
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4783
Mailing Address - Country:US
Mailing Address - Phone:608-791-4156
Mailing Address - Fax:608-791-9898
Practice Address - Street 1:520 AMY DR
Practice Address - Street 2:
Practice Address - City:HOLMEN
Practice Address - State:WI
Practice Address - Zip Code:54636-9337
Practice Address - Country:US
Practice Address - Phone:608-526-3351
Practice Address - Fax:608-526-3412
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI973225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant