Provider Demographics
NPI:1902493539
Name:EGGERT, TERRI (LMT)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:EGGERT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35670 KENAI SPUR HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7649
Mailing Address - Country:US
Mailing Address - Phone:907-262-0801
Mailing Address - Fax:877-803-8297
Practice Address - Street 1:35670 KENAI SPUR HWY STE 104
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7649
Practice Address - Country:US
Practice Address - Phone:907-262-0801
Practice Address - Fax:877-803-8297
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK108557225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist