Provider Demographics
NPI:1437534781
Name:ACKERMAN, SUSAN ALAINE (DPT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ALAINE
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:RHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:16211 N BRINSON ST STE 220
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-5525
Mailing Address - Country:US
Mailing Address - Phone:208-936-2522
Mailing Address - Fax:208-936-2523
Practice Address - Street 1:16211 N BRINSON ST STE 220
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-5525
Practice Address - Country:US
Practice Address - Phone:208-936-2522
Practice Address - Fax:208-936-2523
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-6737225100000X
NV3671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist