Provider Demographics
NPI:1598731044
Name:ACKROYD, KATHLEEN S (PT ATC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:S
Last Name:ACKROYD
Suffix:
Gender:F
Credentials:PT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-8850
Mailing Address - Fax:610-859-7876
Practice Address - Street 1:60 STATE RD
Practice Address - Street 2:STE C
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1452
Practice Address - Country:US
Practice Address - Phone:610-892-7344
Practice Address - Fax:610-565-0500
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00602100225100000X
DE225100000X225100000X
PAPT005457L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE141054ZB82OtherMEDICARE
PAP00692844OtherRAILROAD MEDICARE
0450232000OtherIBC
DE1598731044Medicaid
PA57181OtherPA BLUE SHIELD
PA102335846 0001Medicaid
P00692854OtherRAILROAD MEDICARE
0002280945OtherDPCI
PA145211VLZOtherMEDICARE
PA30061379OtherKEYSTONE MERCY
0450232000OtherIBC