Provider Demographics
NPI:1770907628
Name:ECKENRODE, ROBERT
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ECKENRODE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1888 BRETT LN
Mailing Address - Street 2:
Mailing Address - City:SALTSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15681-8951
Mailing Address - Country:US
Mailing Address - Phone:724-639-8056
Mailing Address - Fax:
Practice Address - Street 1:1888 BRETT LN
Practice Address - Street 2:
Practice Address - City:SALTSBURG
Practice Address - State:PA
Practice Address - Zip Code:15681-8951
Practice Address - Country:US
Practice Address - Phone:724-639-8056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0050062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer