Provider Demographics
NPI:1275019937
Name:ECKERT, DEREK
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:ECKERT
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 1:836 W PLACITA ESTRELLA AZUL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-1595
Mailing Address - Country:US
Mailing Address - Phone:901-598-0017
Mailing Address - Fax:
Practice Address - Street 1:1686 W VALENCIA RD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-6065
Practice Address - Country:US
Practice Address - Phone:520-573-1443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist