Provider Demographics
NPI:1245790104
Name:ACKERMAN, MEGAN EMILIA (PT, DPT, SCS, ATC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:EMILIA
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:PT, DPT, SCS, ATC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:EMILIA
Other - Last Name:SAUNDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:W234S3555 STATE ROAD 59
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-8512
Mailing Address - Country:US
Mailing Address - Phone:262-532-5820
Mailing Address - Fax:
Practice Address - Street 1:W234S3555 STATE ROAD 59
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-8512
Practice Address - Country:US
Practice Address - Phone:262-532-5820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT017783225100000X
WI15345-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist