MEDICARE: COURTNEY EICKELBERG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	8781	MN

General Provider Information

NPI Number	:	1346058062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY EICKELBERG

Provider Business Mailing Address
First Line	:	3300 RICE ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55126-4614
Country	:	US
Telephone Number	:	651-484-8484
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 RICE ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55126-4614
Country	:	US
Telephone Number	:	651-484-8484
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2024
Last Update Date	:	12/27/2024

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Directions to “ COURTNEY EICKELBERG ” Practice Location

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