Provider Demographics
NPI:1164486494
Name:ACKLEY, JULIE D (PT, DMT, COMT, OCS)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:D
Last Name:ACKLEY
Suffix:
Gender:F
Credentials:PT, DMT, COMT, OCS
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:D
Other - Last Name:WHITBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DMT COMT
Mailing Address - Street 1:6264 LEWIS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-3603
Mailing Address - Country:US
Mailing Address - Phone:816-587-8001
Mailing Address - Fax:816-587-8907
Practice Address - Street 1:6264 LEWIS DR
Practice Address - Street 2:STE 102
Practice Address - City:PARKVILLE
Practice Address - State:MO
Practice Address - Zip Code:64152-3603
Practice Address - Country:US
Practice Address - Phone:816-587-8001
Practice Address - Fax:816-587-8907
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02805225100000X
MO118483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266642Medicare ID - Type Unspecified