Provider Demographics
NPI:1932488442
Name:EGGE, JOHN HENNING (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HENNING
Last Name:EGGE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 E BELVIDERE RD
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2289
Mailing Address - Country:US
Mailing Address - Phone:847-548-0360
Mailing Address - Fax:847-548-0716
Practice Address - Street 1:158 S WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5203
Practice Address - Country:US
Practice Address - Phone:847-480-1280
Practice Address - Fax:847-480-1279
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11359225100000X
IL070-019137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist