MEDICARE: MR. JOHN D ACKISS PT,DPT, MS,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	2305004384	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00814677	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5039662	OTHER	VA	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467439737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN D ACKISS PT,DPT, MS,OCS

Provider Business Mailing Address
First Line	:	771 PILOT HOUSE DR
Second Line	:	SUITE A
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-1990
Country	:	US
Telephone Number	:	757-873-2302
Fax Number	:	757-873-2306

Provider Business Practice Location Address
First Line	:	4020 RAINTREE RD
Second Line	:	SUITE D
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-3749
Country	:	US
Telephone Number	:	757-484-4241
Fax Number	:	757-484-4487

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	04/27/2016

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Directions to “ MR. JOHN D ACKISS PT,DPT, MS,OCS” Practice Location

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