Provider Demographics
NPI:1922124627
Name:ECKBERG, WILLIAM REUBEN (RPT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:REUBEN
Last Name:ECKBERG
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 1:24652 520TH AVE
Mailing Address - Street 2:
Mailing Address - City:OSAGE
Mailing Address - State:MN
Mailing Address - Zip Code:56570-9563
Mailing Address - Country:US
Mailing Address - Phone:218-573-1333
Mailing Address - Fax:
Practice Address - Street 1:3400 1ST ST N
Practice Address - Street 2:SUITE 305
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4000
Practice Address - Country:US
Practice Address - Phone:320-255-2393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist