Provider Demographics
NPI:1467418517
Name:EICHORN, KEVEN BARCLAY (LAT,ATC,CSCS)
Entity Type:Individual
Prefix:MR
First Name:KEVEN
Middle Name:BARCLAY
Last Name:EICHORN
Suffix:
Gender:M
Credentials:LAT,ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 167TH BLVD E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-5540
Mailing Address - Country:US
Mailing Address - Phone:941-758-0889
Mailing Address - Fax:
Practice Address - Street 1:3201 N ORANGE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-4744
Practice Address - Country:US
Practice Address - Phone:941-518-6957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer