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:
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 1:815 S MILAM ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4789
Mailing Address - Country:US
Mailing Address - Phone:830-205-1470
Mailing Address - Fax:210-764-0864
Practice Address - Street 1:815 S MILAM ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4789
Practice Address - Country:US
Practice Address - Phone:830-205-1470
Practice Address - Fax:210-864-0764
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2025-02-22
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