Provider Demographics
NPI:1144316845
Name:EAGLESTON, RICHARD ALAN
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:EAGLESTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1779 WOODSIDE RD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3498
Mailing Address - Country:US
Mailing Address - Phone:650-780-9700
Mailing Address - Fax:
Practice Address - Street 1:1779 WOODSIDE RD
Practice Address - Street 2:SUITE #102
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3498
Practice Address - Country:US
Practice Address - Phone:650-780-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT76790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist