Provider Demographics
NPI:1467439737
Name:ACKISS, JOHN D (PT,DPT, MS,OCS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:ACKISS
Suffix:
Gender:M
Credentials:PT,DPT, MS,OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:771 PILOT HOUSE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1990
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:4020 RAINTREE RD
Practice Address - Street 2:SUITE D
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-3749
Practice Address - Country:US
Practice Address - Phone:757-484-4241
Practice Address - Fax:757-484-4487
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004384225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5039662OtherAETNA
VAP00814677OtherRAILROAD MEDICARE
VA1467439737Medicaid
VA1467439737Medicaid
VA00W941A51Medicare PIN
VA5039662OtherAETNA