Provider Demographics
NPI:1881668531
Name:ACKLIN, TIMOTHY EUGENE (ATC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:EUGENE
Last Name:ACKLIN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 MISSOURI
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001
Mailing Address - Country:US
Mailing Address - Phone:575-523-8080
Mailing Address - Fax:575-523-8861
Practice Address - Street 1:2445 MISSOURI
Practice Address - Street 2:SUITE A
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001
Practice Address - Country:US
Practice Address - Phone:575-523-8080
Practice Address - Fax:575-523-8861
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer