Provider Demographics
NPI:1538196696
Name:ECKROAD, JACK E (PT)
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:E
Last Name:ECKROAD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5159 ALABAMA AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH LAWRENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44666-9736
Mailing Address - Country:US
Mailing Address - Phone:330-327-6009
Mailing Address - Fax:
Practice Address - Street 1:2420 WEDGEWOOD DR
Practice Address - Street 2:PHYSICAL THERAPY SUITE
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-2432
Practice Address - Country:US
Practice Address - Phone:330-327-6009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3414225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist