Provider Demographics
NPI:1992132120
Name:ACKER, CHRISTY CORK (MSPT)
Entity type:Individual
Prefix:MS
First Name:CHRISTY
Middle Name:CORK
Last Name:ACKER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 KINGSFORD DRIVE
Mailing Address - Street 2:
Mailing Address - City:MORAGA
Mailing Address - State:CA
Mailing Address - Zip Code:94556
Mailing Address - Country:US
Mailing Address - Phone:404-964-4655
Mailing Address - Fax:
Practice Address - Street 1:478 KINGSFORD DRIVE
Practice Address - Street 2:
Practice Address - City:MORAGA
Practice Address - State:CA
Practice Address - Zip Code:94556
Practice Address - Country:US
Practice Address - Phone:404-964-4655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40350225100000X
GA006290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist