Provider Demographics
NPI:1326252578
Name:ECKLUND, KRISTI (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:
Last Name:ECKLUND
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 PISTOL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-6040
Mailing Address - Country:US
Mailing Address - Phone:719-481-8561
Mailing Address - Fax:719-776-5392
Practice Address - Street 1:2222 N NEVADA AVE
Practice Address - Street 2:PENROSE REHABILITATION
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6819
Practice Address - Country:US
Practice Address - Phone:719-776-5200
Practice Address - Fax:719-776-5392
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist