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General NPI Number Information
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NPI Number | 1609424050
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Entity Type | Individual
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Provider Name | MICHELLE LEANN ECKHOFF PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 08/29/2019
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Last Update Date | 08/29/2019
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Provider Practice Location Address
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Address Line | 1909 N MORTON AVE
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City | MORTON
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State | IL
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Zip | 61550-1426
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Country | US
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Telephone | 309-266-5488
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Fax | 309-266-9144
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Provider Business Mailing Address
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Address Line | 411 HAMILTON BOULEVARD SUITE 1908
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City | PEORIA
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State | IL
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Zip | 61602-1146
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Country | US
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Telephone | 309-674-7874
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Fax | 309-674-7814
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.024643
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License Number State | IL
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