Healthcare Provider Details

I. General information

NPI: 1295758316
Provider Name (Legal Business Name): MARY ELIZABETH ACKERMAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY BETH ACKERMAN PT

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15435 MAIN ST NE # 101
DUVALL WA
98019-8576
US

IV. Provider business mailing address

17618 140TH AVE NE
WOODINVILLE WA
98072-6800
US

V. Phone/Fax

Practice location:
  • Phone: 425-402-9772
  • Fax: 425-402-9443
Mailing address:
  • Phone: 425-402-9772
  • Fax: 425-402-9443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00008405
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: