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NPI Code Detail

MEDICARE: JONATHAN ACKLIE PT

MEDICARE: JONATHAN ACKLIE PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist070011632IL

General Provider Information

NPI Number : 1568437747
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN ACKLIE PT
Provider Business Mailing Address
First Line : 850 43RD AVE
Second Line : SUITE 100
City : MOLINE
State : IL
Zip : 61265-8401
Country : US
Telephone Number : 309-743-2070
Fax Number : 309-743-2073
Provider Business Practice Location Address
First Line : 9901 N. KNOXVILLE AVENUE
Second Line : SUITE D
City : PEORIA
State : IL
Zip : 61615-1433
Country : US
Telephone Number : 309-243-1989
Fax Number : 309-243-8138
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2006
Last Update Date : 04/11/2012

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