Provider Demographics
NPI:1700011228
Name:ACKERSON-HENRY, ANGELA M (PT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:ACKERSON-HENRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 RED ROOF LN
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2983
Mailing Address - Country:US
Mailing Address - Phone:603-898-9947
Mailing Address - Fax:603-898-9949
Practice Address - Street 1:13 RED ROOF LN
Practice Address - Street 2:SUITE 2B
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2983
Practice Address - Country:US
Practice Address - Phone:603-898-9947
Practice Address - Fax:603-898-9949
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH3440225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist