Provider Demographics
NPI:1073843959
Name:ECKSTEIN, HEIDI L (PT)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:L
Last Name:ECKSTEIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 FISH HATCHERY RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53713-3114
Mailing Address - Country:US
Mailing Address - Phone:608-204-6244
Mailing Address - Fax:608-204-6249
Practice Address - Street 1:2875 FISH HATCHERY RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53713-3114
Practice Address - Country:US
Practice Address - Phone:608-204-6244
Practice Address - Fax:608-204-6249
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI6248-24OtherLICENSE NUMBER