1598731044 NPI number — KATHLEEN S ACKROYD PT ATC

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598731044 NPI number — KATHLEEN S ACKROYD PT ATC

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ACKROYD

Provider First Name:

KATHLEEN

Provider Middle Name:

S

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

PT ATC

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1598731044

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/04/2010

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2 W 10TH ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MARCUS HOOK

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

19061-4513

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

610-859-8850

Provider Business Mailing Address Fax Number:

610-859-7876

Provider First Line Business Practice Location Address:

60 STATE RD

Provider Second Line Business Practice Location Address:

STE C

Provider Business Practice Location Address City Name:

MEDIA

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

19063-1452

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

610-892-7344

Provider Business Practice Location Address Fax Number:

610-565-0500

Provider Enumeration Date:

02/24/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 225100000X , with the licence number:  40QA00602100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 225100000X , with the licence number: 225100000X , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 225100000X , with the licence number: PT005457L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 141054ZB82 . This is a "MEDICARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
• Identifier: P00692844 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 0450232000 . This is a "IBC" identifier . This identifiers is of the category "OTHER".
• Identifier: 1598731044 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
• Identifier: 57181 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 102335846 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: P00692854 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 0002280945 . This is a "DPCI" identifier . This identifiers is of the category "OTHER".
• Identifier: 145211VLZ . This is a "MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 30061379 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".