Provider Demographics
NPI:1760928410
Name:ACKERSON, LAURIN
Entity Type:Individual
Prefix:
First Name:LAURIN
Middle Name:
Last Name:ACKERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 5TH AVE E
Mailing Address - Street 2:UNIT 3206
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-3741
Mailing Address - Country:US
Mailing Address - Phone:207-554-9595
Mailing Address - Fax:
Practice Address - Street 1:1901 5TH AVE E
Practice Address - Street 2:UNIT 3206
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-3741
Practice Address - Country:US
Practice Address - Phone:207-554-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer