Provider Demographics
NPI:1689005191
Name:ACKLEY, HEATHER LYNN (DPT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:ACKLEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18271 MCDURMOTT W
Mailing Address - Street 2:J
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6754
Mailing Address - Country:US
Mailing Address - Phone:949-752-2227
Mailing Address - Fax:949-752-2231
Practice Address - Street 1:18271 MCDURMOTT W
Practice Address - Street 2:J
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6754
Practice Address - Country:US
Practice Address - Phone:949-752-2227
Practice Address - Fax:949-752-2231
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT40757225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT40757OtherPHYSICAL THERAPY LICENSE