Provider Demographics
NPI:1205237039
Name:ACKERMANN, ELIZABETH (PT)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:ACKERMANN
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 1:313 1/2 ROSARIO BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1343
Mailing Address - Country:US
Mailing Address - Phone:985-855-5139
Mailing Address - Fax:
Practice Address - Street 1:179 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3495
Practice Address - Country:US
Practice Address - Phone:505-426-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist