Provider Demographics
NPI:1174843627
Name:ACKERMAN, DORIS MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:MARIE
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9373 LEWIS POINT RD
Mailing Address - Street 2:P.O. BOX 655
Mailing Address - City:CANASTOTA
Mailing Address - State:NY
Mailing Address - Zip Code:13032-4213
Mailing Address - Country:US
Mailing Address - Phone:315-697-9334
Mailing Address - Fax:
Practice Address - Street 1:9373 LEWIS POINT RD
Practice Address - Street 2:
Practice Address - City:CANASTOTA
Practice Address - State:NY
Practice Address - Zip Code:13032-4213
Practice Address - Country:US
Practice Address - Phone:315-697-9334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-07
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011682-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist