MEDICARE: AMY ACKER 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
1	261QP2000X	Physical Therapy Clinic/Center	1580	SC

General Provider Information

NPI Number	:	1528364734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY ACKER PT

Provider Business Mailing Address
First Line	:	144 LEISURE LN STE 100
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-4156
Country	:	US
Telephone Number	:	803-888-6125
Fax Number	:	803-888-6085

Provider Business Practice Location Address
First Line	:	144 LEISURE LN STE 100
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-4156
Country	:	US
Telephone Number	:	803-708-3950
Fax Number	:	803-708-3971

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

Provider Enumeration Date	:	02/04/2011
Last Update Date	:	10/02/2023

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