MEDICARE: TIMOTHY ECKERT

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	PT872222	DC

General Provider Information

NPI Number	:	1679069876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY ECKERT

Provider Business Mailing Address
First Line	:	350 NEW FIDELITY CT
Second Line	:
City	:	GARNER
State	:	NC
Zip	:	27529-2665
Country	:	US
Telephone Number	:	919-258-2714
Fax Number	:

Provider Business Practice Location Address
First Line	:	3508 CONNECTICUT AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20008-2401
Country	:	US
Telephone Number	:	389-020-2897
Fax Number	:

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

Provider Enumeration Date	:	07/11/2018
Last Update Date	:	07/11/2018

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