Provider Demographics
NPI:1356431092
Name:EAGAN, VALERIE MARIE (RPT)
Entity type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:MARIE
Last Name:EAGAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MRS
Other - First Name:VALERIE
Other - Middle Name:MARIE
Other - Last Name:RUCCIA EAGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPT
Mailing Address - Street 1:254 NORTH RD
Mailing Address - Street 2:#2
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-1111
Mailing Address - Country:US
Mailing Address - Phone:978-443-0706
Mailing Address - Fax:
Practice Address - Street 1:524 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778-1833
Practice Address - Country:US
Practice Address - Phone:508-358-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY66031OtherBCBS