Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PTL0015319 | CO |
NPI | 1063820272 |
---|---|
Provider Name | Daren Eccles |
First Address | Timnath, CO 80547-2524 |
Second Address | Longmont, CO 80504-5278 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2014 |
Last Update Date | 09/03/2021 |