Provider Demographics
NPI:1952585499
Name:ECKENROD, RUTH S (PTA)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:S
Last Name:ECKENROD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 E RUSK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-5505
Mailing Address - Country:US
Mailing Address - Phone:903-586-8691
Mailing Address - Fax:903-586-4138
Practice Address - Street 1:1521 E RUSK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-5505
Practice Address - Country:US
Practice Address - Phone:903-586-8691
Practice Address - Fax:903-586-4138
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2039600225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant