Basic Information
| Provider Information | |||||||||
| NPI: | 1598731044 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ACKROYD | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | PT ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 W 10TH ST | ||||||||
| Address2: | |||||||||
| City: | MARCUS HOOK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190614513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108598850 | ||||||||
| FaxNumber: | 6108597876 | ||||||||
| Practice Location | |||||||||
| Address1: | 60 STATE RD | ||||||||
| Address2: | STE C | ||||||||
| City: | MEDIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190631452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108927344 | ||||||||
| FaxNumber: | 6105650500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 11/04/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA00602100 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 225100000X | DE | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT005457L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 141054ZB82 | 01 | DE | MEDICARE | OTHER | P00692844 | 01 | PA | RAILROAD MEDICARE | OTHER | 0450232000 | 01 | IBC | OTHER | 1598731044 | 05 | DE | MEDICAID | 57181 | 01 | PA | PA BLUE SHIELD | OTHER | 102335846 0001 | 05 | PA | MEDICAID | P00692854 | 01 | RAILROAD MEDICARE | OTHER | 0002280945 | 01 | DPCI | OTHER | 145211VLZ | 01 | PA | MEDICARE | OTHER | 30061379 | 01 | PA | KEYSTONE MERCY | OTHER |