Provider Demographics
NPI:1467964171
Name:IGNITE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:IGNITE PHYSICAL THERAPY LLC
Other - Org Name:IGNITE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ECKLES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:810-969-4841
Mailing Address - Street 1:867 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-4177
Mailing Address - Country:US
Mailing Address - Phone:810-397-8675
Mailing Address - Fax:
Practice Address - Street 1:867 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-4177
Practice Address - Country:US
Practice Address - Phone:810-969-4841
Practice Address - Fax:810-969-4843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty