Provider Demographics
NPI:1144404831
Name:ECKERT, JEFFREY (DPT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:ECKERT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 S 12TH ST
Mailing Address - Street 2:STE 110
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-4010
Mailing Address - Country:US
Mailing Address - Phone:775-738-0818
Mailing Address - Fax:775-738-0814
Practice Address - Street 1:620 SOUTH 12TH STREET
Practice Address - Street 2:STE. 110
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801
Practice Address - Country:US
Practice Address - Phone:775-738-0818
Practice Address - Fax:775-738-0814
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT662457-2401225100000X
NV2546225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055207Medicare PIN
UTCJ2697Medicare PIN