Provider Demographics
NPI:1841604899
Name:ECKHARDT, WENDY MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:MARIE
Last Name:ECKHARDT
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 10634
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33679-0634
Mailing Address - Country:US
Mailing Address - Phone:863-409-1944
Mailing Address - Fax:
Practice Address - Street 1:311 S ARRAWANA AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3258
Practice Address - Country:US
Practice Address - Phone:863-409-1944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA58974225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist