Provider Demographics
NPI:1295519148
Name:ECKLUND, LAURA ELIZABETH
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ELIZABETH
Last Name:ECKLUND
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 1:17017 KAREN ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-1486
Mailing Address - Country:US
Mailing Address - Phone:402-670-3137
Mailing Address - Fax:
Practice Address - Street 1:23 CEDAR RIDGE DR
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-4160
Practice Address - Country:US
Practice Address - Phone:207-474-9686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4556225100000X
MEPT7073225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist