MEDICARE: SAMERA M ECKL PT

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	PT003643	GA

General Provider Information

NPI Number	:	1649614629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMERA M ECKL PT

Provider Business Mailing Address
First Line	:	2221 PEACHTREE RD NE
Second Line	:	STE D 336
City	:	ATLANTA
State	:	GA
Zip	:	30309-1106
Country	:	US
Telephone Number	:	404-846-0899
Fax Number	:

Provider Business Practice Location Address
First Line	:	2221 PEACHTREE RD NE
Second Line	:	STE D 336
City	:	ATLANTA
State	:	GA
Zip	:	30309-1106
Country	:	US
Telephone Number	:	404-846-0899
Fax Number	:

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

Provider Enumeration Date	:	04/22/2013
Last Update Date	:	04/22/2013

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