Provider Demographics
NPI:1851708911
Name:ECKELMAN, ELLEN (MA,PT,DPT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:ECKELMAN
Suffix:
Gender:F
Credentials:MA,PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2433 COUNTRY PLACE BLVD
Mailing Address - Street 2:BLDING B
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1163
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2433 COUNTRY PLACE BLVD
Practice Address - Street 2:BLDING B
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1163
Practice Address - Country:US
Practice Address - Phone:814-844-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0003927225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist