Provider Demographics
NPI:1629191945
Name:ACKELL, SUSAN B (RPT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:ACKELL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 WHISCONIER RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1819
Mailing Address - Country:US
Mailing Address - Phone:203-826-3135
Mailing Address - Fax:
Practice Address - Street 1:4 BERKSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-1001
Practice Address - Country:US
Practice Address - Phone:203-775-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020243225100000X
CT002741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist