Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 3034 | NH |
NPI | 1124342134 |
---|---|
Provider Name | Bonnie L Eckerman |
First Address | Nashua, NH 03064-2886 |
Second Address | Nashua, NH 03064-2886 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2010 |
Last Update Date | 19/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3034 | STATE LICENSE (01) | NH |