Provider Demographics
NPI:1952364879
Name:ECKERD, PAUL T (PT CERT MDT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:T
Last Name:ECKERD
Suffix:
Gender:M
Credentials:PT CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 PILOT HOUSE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:6049 HARBOUR PARK DRIVE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112
Practice Address - Country:US
Practice Address - Phone:804-639-2359
Practice Address - Fax:804-639-2029
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204538225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010245605Medicaid
VA7212774OtherAETNA
VAP00393927OtherMEDICARE RAILROAD
VA192944OtherBCBS PHYSICAL THERAPY
VAP00393927OtherMEDICARE RAILROAD
VAC05954Medicare PIN