Provider Demographics
NPI:1689200214
Name:ECKERT, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:ECKERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1332 PASADENA AVE S APT 408
Mailing Address - Street 2:
Mailing Address - City:S PASADENA
Mailing Address - State:FL
Mailing Address - Zip Code:33707-3747
Mailing Address - Country:US
Mailing Address - Phone:727-336-0054
Mailing Address - Fax:
Practice Address - Street 1:1332 PASADENA AVE S APT 408
Practice Address - Street 2:
Practice Address - City:S PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-3747
Practice Address - Country:US
Practice Address - Phone:727-336-0054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-15
Last Update Date:2020-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist