Provider Demographics
NPI:1780379156
Name:EICKHOFF, BRYNN
Entity type:Individual
Prefix:
First Name:BRYNN
Middle Name:
Last Name:EICKHOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 SW SAPPERTON RD
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-3803
Mailing Address - Country:US
Mailing Address - Phone:816-506-8724
Mailing Address - Fax:
Practice Address - Street 1:1204 SW SAPPERTON RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64083-3803
Practice Address - Country:US
Practice Address - Phone:816-506-8724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003027558208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation