Provider Demographics
NPI:1659078525
Name:ECKERT, KARINA V (LMT)
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:V
Last Name:ECKERT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 VALLEY STREAM DR
Mailing Address - Street 2:
Mailing Address - City:PINGREE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-9137
Mailing Address - Country:US
Mailing Address - Phone:773-304-6346
Mailing Address - Fax:
Practice Address - Street 1:1051 VALLEY STREAM DR
Practice Address - Street 2:
Practice Address - City:PINGREE GROVE
Practice Address - State:IL
Practice Address - Zip Code:60140-9137
Practice Address - Country:US
Practice Address - Phone:773-304-6346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227016217225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist