Provider Demographics
NPI:1588015481
Name:ECKERT, MINDY JANELLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:JANELLE
Last Name:ECKERT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:J
Other - Last Name:COSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 W WINDCREST ST
Mailing Address - Street 2:STE 130
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4479
Mailing Address - Country:US
Mailing Address - Phone:830-990-6631
Mailing Address - Fax:830-990-1892
Practice Address - Street 1:511 US HIGHWAY 281
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-5708
Practice Address - Country:US
Practice Address - Phone:830-992-2830
Practice Address - Fax:830-992-2831
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1245967225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX526371YNQ4Medicare PIN