Provider Demographics
NPI:1598960023
Name:AKERBERG, RICHARD KENNETH (PTA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:KENNETH
Last Name:AKERBERG
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MCLAREN RD
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-3316
Mailing Address - Country:US
Mailing Address - Phone:197-844-7178
Mailing Address - Fax:
Practice Address - Street 1:5 MIDDLESEX AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-1102
Practice Address - Country:US
Practice Address - Phone:617-591-4647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7552225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant