Provider Demographics
NPI:1790080083
Name:ECKMAN, KYLE M (LMT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:M
Last Name:ECKMAN
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:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:ROBERTS
Mailing Address - State:MT
Mailing Address - Zip Code:59070-0212
Mailing Address - Country:US
Mailing Address - Phone:404-277-0337
Mailing Address - Fax:
Practice Address - Street 1:1 SO. FIRST STREET
Practice Address - Street 2:
Practice Address - City:ROBERTS
Practice Address - State:MT
Practice Address - Zip Code:59070
Practice Address - Country:US
Practice Address - Phone:404-277-0337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT876225700000X
GA000758225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist