Provider Demographics
NPI:1992963375
Name:ECKLES, KEVIN RICHARD (DPT)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:RICHARD
Last Name:ECKLES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1191 S LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3081
Mailing Address - Country:US
Mailing Address - Phone:810-969-4841
Mailing Address - Fax:810-969-4843
Practice Address - Street 1:1191 S LAPEER RD
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3081
Practice Address - Country:US
Practice Address - Phone:810-969-4841
Practice Address - Fax:810-969-4843
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013826225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI6211076Medicare PIN
MIN69750093Medicare PIN