Healthcare Provider Details

I. General information

NPI: 1861669301
Provider Name (Legal Business Name): ADAM THOMAS ACKERMAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 S ROCK AVE
VIROQUA WI
54665-1936
US

IV. Provider business mailing address

E3414 US HIGHWAY 14
COON VALLEY WI
54623-8322
US

V. Phone/Fax

Practice location:
  • Phone: 608-637-6337
  • Fax: 608-637-3839
Mailing address:
  • Phone: 608-498-6702
  • Fax: 608-452-2242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9930024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: