MEDICARE: MRS. JULIE D ACKLEY PT, DMT, COMT, OCS

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
1	225100000X	Physical Therapist	11-02805	KS
2	225100000X	Physical Therapist	118483	MO

General Provider Information

NPI Number	:	1164486494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE D ACKLEY PT, DMT, COMT, OCS

Provider Business Mailing Address
First Line	:	6264 LEWIS DR STE 100
Second Line	:
City	:	PARKVILLE
State	:	MO
Zip	:	64152-3603
Country	:	US
Telephone Number	:	816-587-8001
Fax Number	:	816-587-8907

Provider Business Practice Location Address
First Line	:	6264 LEWIS DR
Second Line	:	STE 102
City	:	PARKVILLE
State	:	MO
Zip	:	64152-3603
Country	:	US
Telephone Number	:	816-587-8001
Fax Number	:	816-587-8907

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	07/26/2022

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