Provider Demographics
NPI:1144657214
Name:EKKEBUS, KEVIN (PT, DPT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:EKKEBUS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 TREYBURN LN
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9418
Mailing Address - Country:US
Mailing Address - Phone:865-335-3637
Mailing Address - Fax:
Practice Address - Street 1:6100 WEST FRIENDLY AVENUE
Practice Address - Street 2:FRIENDS HOME WEST
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410
Practice Address - Country:US
Practice Address - Phone:336-292-9952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP13850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist