Provider Demographics
NPI:1861669301
Name:ACKERMAN, ADAM THOMAS (PT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:THOMAS
Last Name:ACKERMAN
Suffix:
Gender:M
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:E3414 US HIGHWAY 14
Mailing Address - Street 2:
Mailing Address - City:COON VALLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54623-8322
Mailing Address - Country:US
Mailing Address - Phone:608-498-6702
Mailing Address - Fax:608-452-2242
Practice Address - Street 1:614 S ROCK AVE
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-1936
Practice Address - Country:US
Practice Address - Phone:608-637-6337
Practice Address - Fax:608-637-3839
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9930024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist