Provider Demographics
NPI:1215973011
Name:LEGASPI, EDDIESON (PT)
Entity type:Individual
Prefix:MR
First Name:EDDIESON
Middle Name:
Last Name:LEGASPI
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 1:1870 W CARSON ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2848
Mailing Address - Country:US
Mailing Address - Phone:310-212-7946
Mailing Address - Fax:877-389-7789
Practice Address - Street 1:1870 W CARSON ST
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-2848
Practice Address - Country:US
Practice Address - Phone:310-212-7946
Practice Address - Fax:877-389-7789
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024668-1225100000X
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0632AEMedicare PIN