Provider Demographics
NPI:1346389475
Name:ECKHARDT, BRUCE ALAN (PT)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ALAN
Last Name:ECKHARDT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11602 HERMAN ROSER AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-5713
Mailing Address - Country:US
Mailing Address - Phone:505-292-8778
Mailing Address - Fax:
Practice Address - Street 1:3811 COMMONS AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5832
Practice Address - Country:US
Practice Address - Phone:505-345-9599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM239225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist