Provider Demographics
NPI:1144389495
Name:ACKERMAN, DEBORAH EILEEN (PT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:EILEEN
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:EILEEN
Other - Last Name:AULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:132 N LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26041-1029
Mailing Address - Country:US
Mailing Address - Phone:304-845-9550
Mailing Address - Fax:304-845-9540
Practice Address - Street 1:132 N LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:MOUNDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26041-1029
Practice Address - Country:US
Practice Address - Phone:304-845-9550
Practice Address - Fax:304-845-9540
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist