Healthcare Provider Details

I. General information

NPI: 1700963543
Provider Name (Legal Business Name): DANIELLE EKOVICH PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S CALUMET RD STE 3
CHESTERTON IN
46304-3286
US

IV. Provider business mailing address

1120 S CALUMET RD STE 3
CHESTERTON IN
46304-3286
US

V. Phone/Fax

Practice location:
  • Phone: 219-983-9675
  • Fax:
Mailing address:
  • Phone: 219-983-9675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06003228A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: