Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 050115319A | IN |
NPI | 1174124143 |
---|---|
Provider Name | Ellen Nicole Eckhart |
First Address | Fort Wayne, IN 46845-1701 |
Second Address | Fort Wayne, IN 46845-1728 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2020 |
Last Update Date | 25/02/2021 |