Provider Demographics
NPI:1558433649
Name:ECKBERG, KARI (DPT)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:
Last Name:ECKBERG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 N GREENWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-5948
Mailing Address - Country:US
Mailing Address - Phone:509-326-6174
Mailing Address - Fax:
Practice Address - Street 1:9212 E MONTGOMERY AVE
Practice Address - Street 2:#103
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4239
Practice Address - Country:US
Practice Address - Phone:509-922-0855
Practice Address - Fax:509-921-0050
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000073862251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8359648Medicaid