Provider Demographics
NPI:1992521157
Name:EAGON, ERIC BRYANT (LMT)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:BRYANT
Last Name:EAGON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4271 S LAREDO WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-2705
Mailing Address - Country:US
Mailing Address - Phone:720-408-5690
Mailing Address - Fax:
Practice Address - Street 1:1075 S YUKON ST STE 320
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-4333
Practice Address - Country:US
Practice Address - Phone:720-408-5690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0023967225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist