Provider Demographics
NPI:1407804461
Name:ECKEL, MILFRED OLIN III (PT)
Entity Type:Individual
Prefix:DR
First Name:MILFRED
Middle Name:OLIN
Last Name:ECKEL
Suffix:III
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 1:10992 HIGHWAY 51 S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATOKA
Mailing Address - State:TN
Mailing Address - Zip Code:38004-4944
Mailing Address - Country:US
Mailing Address - Phone:901-837-1711
Mailing Address - Fax:901-837-1232
Practice Address - Street 1:10992 HIGHWAY 51 S
Practice Address - Street 2:SUITE 100
Practice Address - City:ATOKA
Practice Address - State:TN
Practice Address - Zip Code:38004-4944
Practice Address - Country:US
Practice Address - Phone:901-837-1711
Practice Address - Fax:901-837-1232
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2580225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3651450Medicaid
TN4041532OtherBLUE CROSS
TN4041532OtherBLUE CROSS