Provider Demographics
NPI:1851505465
Name:EKIERT, CHARLES E (RPT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:EKIERT
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11667 MANATEE BAY LN
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33467-8386
Mailing Address - Country:US
Mailing Address - Phone:561-512-7777
Mailing Address - Fax:
Practice Address - Street 1:318 CARAVELLE DR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-8207
Practice Address - Country:US
Practice Address - Phone:561-255-6229
Practice Address - Fax:561-776-8436
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT5517225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1412AMedicare ID - Type Unspecified