Provider Demographics
NPI:1164457149
Name:ACKLEY, VIVIAN NOYES (PT)
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:NOYES
Last Name:ACKLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 COMMON STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840
Mailing Address - Country:US
Mailing Address - Phone:978-685-6800
Mailing Address - Fax:978-685-0886
Practice Address - Street 1:420 COMMON STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840
Practice Address - Country:US
Practice Address - Phone:978-685-6800
Practice Address - Fax:978-685-0886
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0376086Medicaid