Provider Demographics
NPI:1518951169
Name:ECKARDT, SCOTT (PT)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:ECKARDT
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 1:13020 N TELECOM PARKWAY
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0925
Mailing Address - Country:US
Mailing Address - Phone:813-978-9700
Mailing Address - Fax:135-586-1858
Practice Address - Street 1:5243 HANFF LANE
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685
Practice Address - Country:US
Practice Address - Phone:813-978-9700
Practice Address - Fax:813-558-6185
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018173-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ14P71Medicare PIN