Provider Demographics
NPI:1760203285
Name:ECKHARDT, URSULA (LMT)
Entity type:Individual
Prefix:
First Name:URSULA
Middle Name:
Last Name:ECKHARDT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29524 TAMARACK DR
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:MI
Mailing Address - Zip Code:48134-1323
Mailing Address - Country:US
Mailing Address - Phone:734-447-7875
Mailing Address - Fax:
Practice Address - Street 1:29524 TAMARACK DR
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:MI
Practice Address - Zip Code:48134-1323
Practice Address - Country:US
Practice Address - Phone:734-447-7875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501014051225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist