Healthcare Provider Details

I. General information

NPI: 1063820272
Provider Name (Legal Business Name): DAREN ECCLES DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1566 VISTA VIEW DR
LONGMONT CO
80504-5278
US

IV. Provider business mailing address

5820 CLARET ST
TIMNATH CO
80547-2524
US

V. Phone/Fax

Practice location:
  • Phone: 720-266-7100
  • Fax: 772-221-3373
Mailing address:
  • Phone: 845-380-6408
  • Fax: 772-221-3373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPTL0015319
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: